Who Gets Screened for Cancer? Uptake Gaps Around the World
Published 2026-11-01 · Updated 2026-11-03
Where a country runs an organised screening programme, the share of eligible people screened for breast, cervical or bowel cancer ranges from under 1% to over 85%. Even in long-established programmes, people living in poorer areas, people from some minority ethnic groups and people with a learning disability are screened less often, and these are gaps in how services reach people, not failings of the people missed.
Screening programmes are built to find cancer, or the changes that come before it, in people who feel well. That only works if the invitation reaches someone, makes sense to them, and leads to a test they can get to and go through. When any of those steps fails, the programme quietly misses the people it was designed for. This article sets out what the published programme records and surveys show about who is screened around the world, who is missed, and which changes to the way programmes work have raised uptake. It describes populations and services. It is not guidance on whether or when any individual should be screened.
Coverage ranges from under 1% to over 85% between national programmes
The most complete international picture of organised screening comes from CanScreen5, a repository run by the International Agency for Research on Cancer (IARC) to which countries report their own programme data. In its first published analysis, 84 countries reported data on breast (57 countries), cervical (75) and colorectal (51) screening programmes[3]. Reported coverage ranged:
- Breast: from 1.7% in Bangladesh to 85.5% in England[3].
- Cervical: from 2.1% in Côte d’Ivoire to 86.3% in Sweden[3].
- Colorectal: from 0.6% in Hungary to 64.5% in the Netherlands[3].
These are programme figures supplied by each country, so the age bands, intervals and reference years differ from one country to the next; they show the spread, not a league table. England’s 85.5% for breast screening, for example, is a coverage figure reported to CanScreen5 on the programme’s own definition and year; it is not the same measure as the 70.6% uptake of invitations in 2024–25 reported below, and the two should not be read as a change over time. The authors flag “lack of data to estimate performance indicators across the screening continuum” as a concern, and conclude that “program organization requires improvement in resource-limited settings”[3]. The resource-limited settings the authors describe are often also the ones least able to count who has been screened.
Most women in lower-income countries have never had a cervical screening test
For cervical screening there is a worldwide estimate. A synthetic analysis with World Health Organization co-authors, combining survey and programme data for 202 countries and territories, estimated that in 2019 just 36% of women aged 30–49 had ever been screened, 32% in the previous five years and 28% in the previous three[1]. In the authors’ words, “two in three women aged 30-49 years have never been screened for cervical cancer”[1].
The gap by country income is stark. An estimated 84% of women aged 30–49 in high-income countries had ever been screened, against 48% in upper-middle-income, 9% in lower-middle-income and 11% in low-income countries[1]. These are modelled estimates from the year before the COVID-19 pandemic, and “ever screened” is a low bar: it does not mean screened at the recommended interval, or followed up after an abnormal result. The vaccine half of cervical cancer prevention, and the WHO elimination targets, are covered in our article on the HPV vaccine and cervical cancer.
Even long-established programmes miss around three in ten eligible people
Countries with long-established programmes still do not reach everyone. In England, the NHS breast screening programme invited 2.75 million women aged 50 to under 71 in 2024–25, and 70.6% took up their invitation, up from 70.0% the year before[4]. In the cervical programme, 68.8% of eligible people aged 25 to 64 were adequately screened at 31 March 2024, a coverage measure that barely moved from 68.7% the year before[5]. Scotland’s bowel screening programme, which posts a home test kit to people aged 50 to 74, had 65.2% uptake for invitations from May 2023 to April 2025, above its 60% minimum target[2].
In the United States, where screening is mostly arranged through individual healthcare rather than national invitation, the main source is a household survey. In 2023, 75.8% of women aged 21–65 reported being up to date with cervical screening, against a national Healthy People 2030 target of 84.3%, and the recent trend (2019–2023) is classed as falling[6]. For colorectal screening, 72.6% of adults aged 50–75 were up to date, close to a target of 74.4%[7].
| Where and when | Programme | Measure | Figure |
|---|---|---|---|
| England, 2024–25 | Breast, women 50 to under 71 | Uptake of invitations (programme records) | 70.6%[4] |
| England, 31 March 2024 | Cervical, ages 25–64 | Coverage, adequately screened (programme records) | 68.8%[5] |
| Scotland, invitations 2023–25 | Bowel, ages 50–74 | Uptake, kit returned (programme records) | 65.2%[2] |
| United States, 2023 | Cervical, women 21–65 | Up to date (self-reported survey) | 75.8%[6] |
| United States, 2023 | Colorectal, adults 50–75 | Up to date (self-reported survey) | 72.6%[7] |
Uptake, coverage and self-reported “up to date” status measure different things, over different age bands, so the rows are not directly comparable. Surveys rely on people remembering when they were last tested; programme records count only tests the programme knows about.
Poorer areas, some ethnic groups and people with a learning disability are screened less often
Averages hide who is missed. The same pattern appears in very different health systems.
Deprivation and income
In Scotland, bowel screening uptake was 74.4% in the least deprived fifth of areas but 52.3% in the most deprived, a gap of 22.1 percentage points; uptake in the most deprived areas fell below the programme’s 60% minimum target[2]. In the United States in 2023, 63.3% of adults aged 50–75 in families below 200% of the federal poverty level were up to date with colorectal screening, against 75.7% of those at or above it; for cervical screening the figures were 67.6% and 79.1%[7][6]. Two countries, two very different ways of organising care, and in both the people with least money are screened least. The wider pattern of cancer outcomes by deprivation is set out in our article on deprivation and cancer.
Ethnicity
Many programmes do not record ethnicity at all, which is itself part of the problem. Scotland’s bowel programme does not, so Public Health Scotland linked screening records to ethnicity recorded elsewhere in the health service, in a pilot published as official statistics in development. For invitations from May 2022 to April 2024, uptake ranged from 70.8% among people recorded as White: Other British to 42.2% among people recorded as Bangladeshi, Scottish Bangladeshi or British Bangladeshi, against 66% overall[8]. People whose ethnicity could not be assigned at all had uptake of just 27.7%, and people were more likely to fall into that unassigned group if they were younger, male or living in more deprived areas[8]: the people the data systems lose track of are also the people screening misses. In the United States, colorectal screening was reported by 75.3% of non-Hispanic White adults aged 50–75, 72.5% of non-Hispanic Black adults and 62.9% of Hispanic adults in 2023[7]. These differences sit alongside differences in income, language and access, and the sources do not separate them. The wider evidence is in our article on ethnicity and cancer.
Learning disability
People with a learning disability (intellectual disability in international usage) are consistently screened less often, according to reviews of the evidence. A 2024 systematic review and meta-analysis found that people with intellectual disabilities had lower odds of taking part in colorectal screening than people without (odds ratio 0.65, 95% CI 0.53–0.79), and lower still for home stool tests (odds ratio 0.58, 95% CI 0.49–0.69)[9]. A 2026 scoping review of 78 studies for the European EUCanScreen Joint Action, mostly on breast, cervical and bowel screening, found that “people with ID consistently showed lower participation than the general population”[10].
An odds ratio is not a percentage: 0.65 means the odds of participating were about a third lower, not that a third fewer people took part. We looked for current national figures for England comparing screening among people with and without a learning disability, and could not verify them at source for this article. That absence is a finding in itself: a group with known health inequalities should not be hard to count.
Simpler tests that come to people raise uptake, including among those missed before
The strongest evidence on what raises uptake comes from changes to the test itself and to how it reaches people, tested within national programmes.
An easier home test for bowel screening. In a 2014 pilot within England’s national bowel screening programme, around one in 28 people invited over six months (40,930 people) were sent a faecal immunochemical test (FIT) instead of the older guaiac faecal occult blood test (gFOBt). Overall uptake rose from 59.3% to 66.4% (odds ratio 1.35, 95% CI 1.33–1.38)[11]. Among people who had not responded to previous invitations, uptake almost doubled, from 12.5% to 23.9%[11]. The increase was seen across all deprivation fifths and was larger in men than in women[11]; in Scotland’s current programme, for comparison, uptake was 62.7% among men and 67.7% among women[2].
Self-sampling kits for cervical screening. In July 2023 the Dutch national programme began posting HPV self-sampling kits directly: with the first invitation to 30-year-olds, and to people in other age groups who had not responded 12 weeks after their invitation. A population-based study compared people invited between July and December 2023 with those invited in the same months of 2022, before the change, so it is a before-and-after comparison rather than a trial. Participation rose from 42.1% to 49.9% (relative risk 1.19, 95% CI 1.18–1.19), with the largest rise after a first invitation among 30-year-olds, from 30.6% to 40.3%[12]. The participation figures here are for the study’s own invitation rounds, and are not the same measure as England’s coverage figure above.
Neither change closes the gaps on its own. Scotland’s programme already uses a home kit, and the 22-point deprivation gap remains[2]. The EUCanScreen review of screening for people with intellectual disability sets out barriers and improvement strategies beyond the test itself[10]. Screening also only helps if a positive result leads promptly to diagnosis and treatment: why finding cancer early changes outcomes so much is covered in our article on stage at diagnosis.
What the evidence asks of us
The figures point less to individual choices than to the design of programmes. Read together, they ask several things of health systems, commissioners and funders:
- Build programmes where there are none. With an estimated 9–11% of women aged 30–49 in lower-income countries ever screened for cervical cancer[1], and CanScreen5 concluding that programme organisation needs improvement in resource-limited settings[3], the largest gains are in funding and organising screening, alongside treatment for what it finds, where it barely exists today.
- Count who is missed. Programmes should be able to report uptake by deprivation, ethnicity and disability. Scotland’s pilot shows that linking records can do this where programmes do not record ethnicity themselves[8], and CanScreen5 names the lack of data across the screening pathway as a concern[3].
- Judge programmes by their gaps, not only their averages. A bowel programme can pass its 60% minimum target overall while its most deprived areas fall short of it[2]. Targets set for each group would make that visible.
- Make the test easier to do. Simpler home tests and kits sent directly to people raised participation in a national pilot in England and across the Dutch national programme, including among people missed before[11][12].
- Make reasonable adjustments routine. The consistent gap for people with intellectual disability[9][10] calls for adjustments planned into every stage of programmes, rather than left to chance.
Charities and support groups already do much of this work: translating invitations, supporting people with a learning disability, going into communities that letters do not reach. The data make the case that this is core to whether a screening programme works, and should be funded as such. More from the library at our cancer research hub.
Language: this piece says "people with cancer" and "people living with and after cancer", and describes the illness and its treatment plainly, without combat metaphors. Clinical terms such as "stage", "incidence" and "net survival" are used in the sense the cited source defines them.
Why we're publishing this
Screening statistics are usually reported as a single national percentage, and that number can look reassuring while whole communities are being missed. Charities, community groups and hospices see those gaps up close. We have brought the population figures together, with their sources, so that organisations working with people affected by cancer can make the case for programmes that reach everyone, using numbers that stand up to scrutiny.
How to read this data
- Coverage, uptake and participation are different measures. Coverage is the share of the whole eligible population screened within a set interval (England’s cervical figure). Uptake is the share of people invited in a period who were screened (England’s breast and Scotland’s bowel figures). Participation is used in the Dutch study for the share of invited people who took part. US figures are self-reported “up to date” status from a household survey. They are not interchangeable.
- Programme data and survey data differ. Programme records count tests the programme knows about; surveys depend on what people remember and report. CanScreen5 figures are supplied by each country and use national definitions, age bands and years.
- Age bands and intervals vary. Each figure here gives its own eligible age range; programmes in different countries invite different ages at different intervals.
- The global cervical estimate is modelled. It combines surveys and programme data, refers to 2019, and counts anyone ever screened, so it overstates regular screening.
- Odds ratios are not percentages and, when the outcome is common, overstate the difference in risk. Inequality figures are associations: they show who is missed, not why.
- Uptake is not the only measure of a good programme. Screening also has harms, including false-positive results and overdiagnosis, and many programmes aim for informed participation rather than the highest possible figure. The gaps described here matter because they fall repeatedly on the same groups, not because every eligible person is expected to be screened.
- Where the evidence is thin. Most detailed breakdowns by deprivation, ethnicity and disability come from a few high-income countries, chiefly the UK and US. Countries with the lowest coverage often have the least data on who is missed.
Use this data
Free to cite with attribution to Better Health For Everyone. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.
Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.
Sources
- Bruni L, Serrano B, Roura E, et al. Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: a review and synthetic analysis. The Lancet Global Health, 2022;10(8):e1115-e1127. europepmc.org/article/MED/35839811
- Public Health Scotland. Scottish bowel screening programme statistics, for the period of invitations from May 2023 to April 2025. Public Health Scotland, 2026. publichealthscotland.scot/…/may-2023-to-april-2025
- Zhang L, et al. CanScreen5, a global repository for breast, cervical and colorectal cancer screening programs. Nature Medicine, 2023. europepmc.org/article/PMC/PMC10202799
- NHS England. Breast Screening Programme, England, 2024-25. NHS England Digital, 2026. digital.nhs.uk/…/breast-screening-programme/england-2024-2025
- NHS England. Cervical Screening Programme, England - 2023-2024 [NS]. NHS England Digital, 2024. digital.nhs.uk/…/cervical-screening-annual/england-2023-24
- National Cancer Institute. Cancer Trends Progress Report: Cervical Cancer Screening (National Health Interview Survey data). NCI, accessed 2026. progressreport.cancer.gov/detection/cervical_cancer
- National Cancer Institute. Cancer Trends Progress Report: Colorectal Cancer Screening (National Health Interview Survey data). NCI, accessed 2026. progressreport.cancer.gov/detection/colorectal_cancer
- Public Health Scotland. Scottish bowel screening uptake statistics by race and ethnicity: pilot study of the application of PHS race and ethnicity index. Public Health Scotland, 2025. publichealthscotland.scot/…/scottish-bowel-screening-uptake-statistics-by-race-and-ethnicity
- Ricciardi GE, et al. Disability and Participation in Colorectal Cancer Screening: A Systematic Review and Meta-Analysis. Current Oncology, 2024. europepmc.org/article/MED/39590148
- Koko C, et al. Cancer screening in people with intellectual disability: a scoping review of participation, barriers, facilitators, and improvement strategies within the EUCanScreen initiative. International Journal for Equity in Health, 2026. europepmc.org/article/MED/42563167
- Moss S, et al. Increased uptake and improved outcomes of bowel cancer screening with a faecal immunochemical test: results from a pilot study within the national screening programme in England. Gut, 2017. europepmc.org/article/MED/27267903
- Olthof EMG, Siebers AG, de Kok IMCM. Effect of direct mailing self-sampling kits on participation in the Dutch hrHPV-based cervical screening programme: a population-based study. The Lancet Regional Health – Europe, 2026. europepmc.org/article/MED/41847601
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