People with a learning disability are at higher risk of developing bowel cancer, yet face significant barriers at nearly every stage of the care pathway, University of Manchester and Christie NHS Foundation Trust have found.
The population-based study of more than two million people showed individuals with an intellectual disability are more likely to develop bowel cancer, especially before the age of 50.
Funded by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), the study is published in BMC Medicine today (20/05/26). The research team is supported by both the NIHR GM PSRC and the NIHR Manchester Biomedical Research Centre (BRC).
People with an intellectual disability present to their GP more often with symptoms linked to bowel cancer, but are less likely to receive key investigations such as stool tests, urgent referrals, or endoscopy the team show.
They were less likely to be diagnosed through screening programmes and more likely to be diagnosed in emergency settings or even on the date of death.
And they were also more likely to be diagnosed at stage IV, when the cancer has already spread.
Among those with early-stage disease, rates of curative surgery were similar, but survival remained significantly worse for people with an intellectual disability.
For advanced bowel cancer, individuals with an intellectual disability were far less likely to receive systemic anticancer therapy, which may contribute to poorer outcomes.
The findings highlight multiple missed opportunities for earlier diagnosis, including lower use of stool tests used to check for early signs of bowel cancer and fewer urgent suspected cancer referrals.
The researchers used anonymised GP records from a large UK database containing information on about 50 million people.
The records were linked with national data on deaths, cancer, hospital care, ethnicity and deprivation to support the research.
The study also raises concerns that current screening programmes, which often begin at age 50, may not adequately protect people with an intellectual disability, given their higher risk at younger ages.
They also highlight that emergency diagnoses can limit the time available for coordinated treatment planning, which may contribute to poorer survival even when surgery is offered.
However, lifestyle factors linked to early-onset bowel cancer—such as obesity, diet, and physical inactivity—may be more common among people with an intellectual disability, potentially amplifying their risk.
And distinguishing concerning symptoms may be more challenging for people with learning disabilities, though the researchers caution that this does not fully explain the scale of under-investigation.
Lead author Dr Oliver Kennedy, Clinical Lecturer at The University of Manchester and The Christie said: “Our findings show clear and avoidable inequalities in bowel cancer diagnosis and treatment for people with an intellectual disability, and they underline the urgent need for earlier screening and more proactive investigation of symptoms.”
Jon Sparkes OBE, Chief Executive of learning disability charity Mencap, said: “This study lays bare the stark truth that people with a learning disability are being diagnosed with bowel cancer too late, too often, and are missing out on chances for earlier treatment that could save lives. We need the NHS, government and cancer services to join us in making inclusive health a priority, acting on these findings and putting the right support in place at every stage of the cancer pathway.”
Claire Coughlan, Clinical Lead at Bowel Cancer UK, said: “Bowel cancer is treatable and curable, especially if it is diagnosed early. However, this study makes clear that people with an ID are not only at increased risk of developing bowel cancer; they also face considerable barriers which can lead to later diagnosis and treatment.”
“The University of Manchester is a public research university in Manchester, England. The main campus is south of Manchester City Centre on Oxford Road.”
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