Closing the Gap: The Role of Pharmacy in Driving Bowel Screening Uptake in Ireland
Source: Irish Pharmacy News, April 2026, pages 26, 28 and 29.
As BowelScreen expands and demand on services grows, pharmacists are uniquely positioned to influence participation, address misconceptions, and support both prevention and early detection – particularly through the programme’s ability to identify and remove pre-cancerous abnormalities before they develop into cancer – but challenges remain.
A Preventable Gap
Bowel cancer is one of the most common cancers in Ireland, but screening plays a powerful role in both preventing cancer through the removal of pre-cancerous abnormalities and detecting it at an early stage when outcomes are significantly improved. BowelScreen, our national bowel screening programme has made significant progress in reducing mortality by identifying cancers at an earlier stage and preventing disease through the removal of abnormal growths. Yet despite its proven clinical and economic benefits, participation remains stubbornly below target.
This gap between availability and uptake is now one of the most pressing challenges facing the programme. With planned expansion to wider age groups and increasing demand across the health system, attention is turning to how participation can be improved – and critically, who is best placed to influence it.
Community pharmacy, with its accessibility, trust, and frequency of patient interaction, is increasingly being recognised as a key part of the solution.
The Current Landscape: Progress and Pressure
BowelScreen currently offers free screening every two years to men and women aged 57 to 71 as of April 1st, 2026. The programme is designed primarily to prevent bowel cancer developing through the identification and removal of polyps which, if left untreated, can progress to cancer over time. It can also detect cancer at an earlier stage, when treatment is more effective.
Each year, around 3,000 people undergo removal of pre-cancerous growths following screening – representing thousands of cancers that may never develop. When cancers are detected through the programme, they are more likely to be identified at an earlier stage, significantly improving treatment outcomes.
However, participation remains a major concern. As of 2022-2023 (latest available data), uptake stood at 46.4%, well below the programme’s achievable target of 60%. This represents a substantial missed opportunity for early intervention. Increasing uptake is essential if screening is to deliver its full benefit in reducing cancer burden and improving outcomes.
At the same time, expansion of the programme is expected to significantly increase demand. HIQA analysis indicates that extending screening to younger age groups could result in up to 219,000 additional invitations annually. This will have implications not only for primary care, but also for downstream services such as endoscopy, histopathology, and radiology.
What the Evidence Tells Us: Driving Participation
Improving screening uptake is a complex challenge, and international evidence offers valuable insights into what can influence participation.
HIQA recently examined international evidence relating to screening uptake in the context of a Health Technology Assessment (HTA) examining potential further age expansion of the BowelScreen programme. Specifically, HIQA were requested by the National Screening Advisory Committee to undertake a HTA of extending BowelScreen to include those aged 50 to 54 years. This HTA was delivered to the National Screening Advisory Committee in December 2025.
HIQA analysis indicates that extending screening to those aged 50 to 54 could result in up to 219,000 additional invitations annually. This will have implications not only for primary care, but also for downstream services such as endoscopy, histopathology, and radiology.
According to HIQA, a range of interventions have been shown to improve engagement. These include enhanced communication strategies, behavioural science-informed messaging, and alternative delivery models.
Digital engagement is also playing an increasing role. In Ireland, BowelScreen uses a combination of traditional, digital and social media campaigns to raise awareness and encourage participation, with further national campaigns planned. Alongside this, targeted messaging – particularly for younger eligible populations – has shown potential in supporting awareness and engagement, including among individuals aged 50 to 54.
In Ireland, the BowelScreen programme has trialled the FIT Direct approach, whereby test kits are sent directly to eligible individuals without requiring them to opt in. This significantly increased participation rates, particularly among those who had not responded to previous invitations.
However, this approach also highlighted operational challenges. While uptake improved, there was a corresponding increase in unsatisfactory samples, demonstrating the importance of balancing accessibility with quality and usability.
Behavioural science is now being incorporated more systematically into programme design. The “Better Letters” initiative, developed by the National Screening Service, aims to improve uptake by redesigning invitation materials to better align with how people respond to information.
Marketing campaigns have also demonstrated impact. A 2023 BowelScreen campaign linked to the lowering of the screening age resulted in a 279% increase in registrations during the campaign period, highlighting the importance of sustained public engagement.
Understanding the Barriers: More Than Access
Despite these efforts, participation continues to be shaped by a complex interplay of emotional, psychological, and practical factors.
HIQA’s assessment noted that many barriers are rooted in patient perception rather than system design. Feelings of embarrassment or discomfort associated with stool-based testing remain common, while fear – both of a cancer diagnosis and of follow-up procedures – can deter participation.
Misunderstanding is another key issue. Many individuals incorrectly believe that screening is only relevant if they are experiencing symptoms or have a family history of cancer. This misunderstanding undermines the fundamental purpose of screening, which is to detect disease before symptoms appear.
Broader social determinants further influence participation. Lower uptake is associated with socioeconomic deprivation, rural residence, and certain ethnic backgrounds, reflecting wider inequalities in access to healthcare services.
Vulnerable populations – including individuals with intellectual disabilities, mental health conditions, or unstable housing – face additional barriers. These may include difficulties receiving invitations, understanding screening information, or attending appointments.
Gender differences are also evident, with men consistently less likely to participate in screening programmes than women.
Addressing these barriers requires a multifaceted approach, combining system-level interventions with personalised engagement.
Pharmacy: A Unique Point of Influence
Within this context, community pharmacy offers a unique opportunity to influence behaviour.
HIQA’s findings highlight the scale of engagement within the pharmacy setting. A 2024 study found that 88% of the population had visited a pharmacy in the previous month, and more than half within the past week. This frequency of contact is unmatched by most other healthcare settings.
HIQA noted that this accessibility positions community pharmacy as a valuable platform for opportunistic health promotion.
Evidence supports this potential. A small Irish pilot study found that pharmacist-assisted enrolment increased uptake to 73.9%, compared with 38% in the general population. While further research is needed to confirm these findings at scale, they highlight the potential impact of pharmacy-based interventions.
The Community Pharmacy Agreement 2025 reflects this growing recognition. The agreement includes provisions for pharmacist involvement in promoting BowelScreen enrolment, with financial support for this activity.
The HSE has confirmed that implementation will begin in 2026, starting with training and health promotion initiatives. Pharmacists will play a role in encouraging participation and supporting registration, while the HSE will retain responsibility for issuing and processing FIT kits.
Frontline Reality: Opportunity Meets Constraint
While the strategic case for pharmacy involvement is clear, successful implementation will depend on practical considerations and effective system design.
Ian Clarke, Superintendent Pharmacist at Clarke’s Pharmacy in Galway, welcomes the recognition of pharmacy’s role and the opportunity this presents for the profession.
“There is no other profession that is as accessible to the public as community pharmacy,” he says. “It is very encouraging to see this recognised at policy level, and that there is a move towards appropriately supporting and resourcing these services.”
He notes that with the right structures in place, pharmacy is well positioned to play a meaningful role in supporting screening initiatives.
“As with any new service, ensuring that processes are efficient and well-designed will be key. If implemented effectively, this has the potential to deliver real benefits for patients while making best use of the accessibility and expertise within community pharmacy.”
This reflects a broader tension between policy ambition and operational capacity. For pharmacy involvement to be sustainable, processes will need to be streamlined and aligned with existing workflows.
Improving uptake will require both broad awareness campaigns and targeted, local engagement.
National campaigns have demonstrated their effectiveness, but sustained visibility is key. Clarke suggests that partnerships with organisations such as the GAA could help maintain public awareness and reach key demographics, particularly men.
At a local level, pharmacy teams can integrate screening into everyday interactions. Linking bowel screening to other preventative services – such as flu vaccination or blood pressure monitoring – can help normalise the conversation and reduce stigma.
Correcting Misconceptions and Supporting Patients
Pharmacists are well placed to address common misconceptions.
“A lot of patients think screening is only for people with symptoms or a family history,” Ian explains. “There can also be fear of an invasive procedure, when in reality it’s a simple at-home test.”
Máirín Ryan, Deputy Chief Executive and Director of Health Technology Assessment at HIQA, emphasises that clear communication is essential. Screening is designed for individuals without symptoms, and a positive result does not mean a cancer diagnosis – it simply indicates that further investigation is required.
Pharmacists can also reinforce the importance of repeat participation, explaining that intermittent bleeding means regular screening increases the likelihood of detection.
Clinical Vigilance and Referral
While screening targets asymptomatic individuals, pharmacists must remain vigilant for red flag symptoms.
These include persistent changes in bowel habits, blood in the stool, unexplained weight loss, fatigue, and abdominal discomfort.
Appropriate referral remains essential, ensuring that symptomatic patients are directed to further investigation without delay.
Preparing for the Future
Looking ahead, bowel screening is likely to evolve.
Emerging research is exploring new approaches, including risk-based screening models and less invasive testing methods such as blood-based biomarkers. While these innovations are not yet part of national programmes, they may shape future strategies.
At the same time, increased participation will place additional demands on healthcare services, highlighting the need for coordinated planning across the system.
Improving bowel screening uptake in Ireland will require a coordinated effort across policy, practice, and public engagement.
Community pharmacy has a critical role to play, offering accessibility, trust, and frequent patient contact. However, realising this potential will depend on ensuring that pharmacists are supported and integrated effectively into the programme.
As BowelScreen expands, the challenge will be not just to extend access, but to translate that access into meaningful participation.
In that effort, pharmacy may prove to be one of the most powerful tools available – helping to close the gap between invitation and action, and ultimately saving lives.
HSE Response
“BowelScreen is the free national bowel screening programme for men and women aged 58 to 70. The primary goal of BowelScreen is to reduce mortality from bowel cancer. We aim to prevent cancers from developing by finding and removing small growths (called polyps), which can turn into cancer if left untreated. Every year around 3,000 people have pre-cancerous growths removed because they did our BowelScreen test. These are all potential cancers prevented. In addition, if cancer is diagnosed through BowelScreen testing it is more likely to be found at an early stage when treatment may lead to a better outcome.
“Over time, the HSE will expand the screening programme to people aged 55 to 74.
“People can expect their first invitation for bowel screening between their 58th and 60th birthday. Taking part in BowelScreen is now even easier as people can request their kit 24/7 through an online register. You can use the new online system to check if you are registered with BowelScreen, provide your contact details, check when your next test is due and request a home test kit.
Pharmacist Involvement
“The HSE is engaging with pharmacies and other relevant stakeholders and planning is under way to implement the measures outlined in the Community Pharmacy Agreement 2025, in relation to pharmacist involvement in the BowelScreen programme. We have met the Irish Pharmacy Union, and look forward to working with community pharmacies to implement this agreement and work together to support more people to choose screening.
“The agreement sets out the key actions to ensure collaboration and integration between the HSE and pharmacists. In relation to the respective responsibilities in the agreement, it sets out that the HSE will “maintain responsibility for issuing FIT kits and processing returned tests”.
“As per the timelines identified in the agreement, it will be rolled out in a phased basis starting in 2026, starting with the training and health promotion activity.”