The bowel screening kit arrived for my 50th and I'd honestly rather just pay for a colonoscopy and know. Am I being daft?

Back again, and this time it's a happy birthday from the screening programme.

The home stool kit arrived in the post. You do a tiny sample on a stick, post it back, and they look for blood. Which is fine, I'll do it, I'm not squeamish. But I keep thinking: a camera actually looks at the whole bowel. A sample on a stick feels like checking a house for damp by sniffing the letterbox.

A colleague paid for a private colonoscopy last year and says she has "peace of mind for ten years". I could afford it if I cut back. Is the kit a lesser version I'm being given because it's cheaper for the health service, or is it genuinely a good test?

The damp and the letterbox line is very good and I'm going to steal it, but I think it's the wrong picture. The kit isn't one sniff, it's a sniff every year or two for decades. The schedule is the test, not the single sample.

My mum has done the kit for years, including two after the invitations stopped because she rang up and asked. One came back positive about six years ago and she had a colonoscopy within a few weeks. Two small polyps removed, nothing else, back on the kits. So the cheap test led her straight to the camera when it mattered.

Also, and I say this with love: the prep for a colonoscopy is not something you do for fun. Her words, not mine, and she used stronger ones.

Different angle. Ask your colleague who's going to tell her the ten years starts again, and whether she'd have done anything differently if her kit had come back negative. Peace of mind is real but it's also what the camera is being sold as.

rhona_k said:

Is the kit a lesser version I'm being given because it's cheaper for the health service, or is it genuinely a good test?

Rhona, the honest answer is that it's a genuinely good test, and the reason it's good is the one gregor gave: it works as a programme, not as a single event.

Stool tests like FIT look for blood you can't see. Done every year or two, repeated stool testing has been shown in randomised trials to reduce deaths from bowel cancer in the people offered it, which is a stronger result than most screens on this site can claim. Colonoscopy has its own big advantage, it can find and remove polyps in the same sitting, which is how screening can prevent some cancers rather than just catch them. But it's invasive, needs a bowel prep and usually sedation, and carries a small risk of complications like bleeding or, rarely, perforation. That's why most programmes use the kit as the first step and keep the camera for the people whose kit is positive, exactly as happened with Fi's mum.

So the kit isn't a second best you've been fobbed off with. Both approaches are recognised options, and which is right for an individual depends on things like family history and personal risk, which is a conversation for your GP, not a checkout page. If there's bowel cancer in your close family, or you ever have symptoms such as bleeding, a change in bowel habit that lasts, or unexplained weight loss, that changes things and you shouldn't wait for a kit at all.

The full comparison, including intervals, is in the colorectal cancer screening guide, and why "looking at everything" isn't automatically safer is in the harms of over-testing.

Done and posted. Not the most glamorous thing I've done on a Sunday morning but it took five minutes.

Asked my GP about the family history question while I was in for something else: no bowel cancer on either side that anyone knows of, so she said the kit is exactly what she'd recommend for me and to keep doing it every time it comes. Colonoscopy money is staying in the bank. I'll report back if the result is anything other than boring.