Colorectal cancer remains one of the most commonly diagnosed cancers in Ireland and a leading cause of cancer-related mortality. Population-based screening has been shown to reduce mortality through earlier detection and intervention, and BowelScreen, the national colorectal cancer screening programme, has become a cornerstone of Ireland’s cancer prevention strategy.
In recent years, growing attention has been paid internationally and nationally to the burden of colorectal cancer in younger adults and to the optimal age at which screening should begin. Against this backdrop, HIQA was asked by the National Screening Advisory Committee (NSAC) to conduct a health technology assessment (HTA) exploring the potential extension of BowelScreen to people aged 50 to 54. This work resulted in the approval by the Minister for Health on 14 April of a recommendation to extend the programme in this way.
BowelScreen, the National Bowel Screening Programme, is provided by the HSE’s National Screening Service (NSS). It was introduced in 2012 with a phased implementation plan targeting men and women aged 60-69 years, and was one of the first national screening programmes to use the faecal immunochemical test (FIT) as the primary screening test. FIT is a simple home test that looks for tiny traces of blood in a stool sample. People who are eligible for screening are invited automatically by post and sent a FIT kit to complete at home and return free of charge. Most people will have a normal result and will be invited again in-line with the screening schedule. If blood above a certain threshold is detected, potentially indicating the presence of a tumour or of polyps (cancer precursors), the person is contacted by BowelScreen and offered further assessment, usually a colonoscopy, to find the cause. The programme is designed to make bowel cancer screening as convenient and accessible as possible for the public.
The recent assessment of extending BowelScreen to those aged 50 to 54 was undertaken in the context of an existing policy commitment to expand BowelScreen to include all individuals aged 55 to 74. This commitment reflects longstanding recommendations at national and international level and has seen significant progress in recent years.
Since its initial roll-out, BowelScreen has undergone phased expansion. In early April 2026, it was announced that the programme will expand further to include individuals aged 57 to 71, representing another important milestone towards full implementation of the 55 to 74 age range.
This HTA was requested by the NSAC following submissions received through its annual call for topics. The NSAC is an independent advisory committee which advises the Minister and Department of Health on all new proposals for population-based screening programmes and revisions to existing programmes. At the request of the Department of Health, HIQA carries out HTAs and provides independent, evidence‑based advice to the NSAC to support decisions by the Minister for Health.
Submissions considered by the NSAC concerned whether the age of eligibility for BowelScreen should be extended further downwards, to include people aged 50 to 54. Internationally, several countries have either lowered or are considering lowering the starting age for colorectal cancer screening, reflecting epidemiological trends showing increasing incidence in younger age cohorts.
This assessment built on HIQA’s long-standing involvement in screening policy in Ireland. Notably, one of HIQA’s earliest assessments was its 2009 HTA which considered various options for a population-based colorectal cancer screening programme in Ireland. Following publication of that report, the then Minister for Health and Children requested further analysis to examine the feasibility of introducing such a programme in Ireland within existing resources. Taken together, the evidence from these assessments informed national decision‑making, leading to the establishment of BowelScreen from 2012.
Since that time, HIQA has conducted HTAs across a range of screening and preventive health programmes, including breast, cervical, newborn bloodspot (‘heel prick’) and diabetic retinopathy screening. These assessments have contributed to a strong institutional understanding of the methodological challenges associated with screening, such as lengthy time horizons, uncertainty around uptake, and the complexity in balancing benefits against potential harms.
The HTA followed HIQA’s established methodological framework, which is grounded in international best practice. Once the scope was defined, the assessment incorporated several interlinked strands of analysis.
A systematic review of the clinical evidence examined the effectiveness of colorectal cancer screening in younger age groups, with a particular focus on FIT, the test used by BowelScreen. Outcomes considered included cancer incidence, stage at diagnosis, mortality reduction, and test performance.
Evaluation of the economic and organisational implications of extension of the programme formed a central pillar of the assessment. First, a review of the cost effectiveness of screening in this age group was conducted, assessing whether extending eligibility would represent good value for money within the Irish health system. In addition, a budget impact analysis explored the short- and medium-term affordability and resource requirements of programme expansion, recognising that even cost-effective interventions may pose significant implementation challenges if upfront costs and/or capacity needs are substantial. A thorough description of the organisational impacts of extending the programme, including implications for service delivery and follow‑up care, was provided.
Finally, ethical, patient and social considerations were explored, such as informed participation, acceptability of screening at younger ages, and the potential impact on equity of access. The findings of the full assessment, including HIQA’s advice to the NSAC, can be viewed on HIQA’s publication page at hiqa.ie > Reports & Publications > Health Technology Assessments.
Stakeholder involvement was an integral part of the assessment. HIQA worked closely with the BowelScreen programme, the NSS, and organisations holding relevant Irish data, drawing on their knowledge and experience to ensure that assumptions reflected real-world programme operations and constraints.
Engagement with clinicians, providers of laboratory and radiological services, public health experts and policymakers helped refine the modelling and ensure that findings were robust and reflective of recent developments. This collaborative approach is particularly important for screening HTAs, where implementation feasibility is critical.
Inclusion of patient and public representatives on the expert advisory group supporting the HTA helped ensure considerations regarding aspects such as acceptability and uptake of screening could be appropriately incorporated. This was reinforced by a public consultation process carried out in July and August 2025.
This assessment, conducted alongside ongoing expansion of the programme towards full coverage of those aged 55 to 74, reflects Ireland’s measured, evidence-driven approach to screening policy.
The work builds on HIQA’s long history of performing screening HTAs and demonstrates the value of multidisciplinary expertise. As pharmacists’ roles in prevention, public health and policy engagement continue to expand, awareness of, and involvement in, assessments of this kind can support the profession’s growing contribution to improving population health.
For community pharmacists, changes to BowelScreen eligibility have clear practical implications. Pharmacists are often among the first healthcare professionals asked about screening invitations, eligibility and FIT testing, particularly as thresholds change. A clear understanding of the evidence and rationale behind screening policy supports consistent, evidence‑based communication and public confidence. Recent policy developments, including the Community Pharmacy Agreement 2025, recognise the growing role of pharmacists in health promotion and disease prevention, including a formalised support and engagement role in the BowelScreen programme. As trusted and accessible healthcare professionals, community pharmacists are well placed to encourage informed participation in BowelScreen, support uptake among people with limited contact with other healthcare services, and reinforce broader health promotion and cancer prevention messages.
Susan Spillane
Deputy Director of HTA, HIQA
Highlighted Articles
