First-degree relatives of bowel cancer cases have an approximately twofold risk of the disease compared with those without a family history. The more affected first-degree relatives an individual has the higher the absolute and relative risk for developing bowel cancer. At present, widespread screening of average-risk individuals for bowel cancer occurs in England, however, the Bowel Cancer Screening Programme does not currently provide a framework for the identification of a family history of bowel cancer. The aim is to determine the cost effectiveness and benefits of offering targeted screening to individuals with a first-degree family history of bowel cancer. The primary outcomes examined the prevalence of developing bowel cancer and estimated the cost effectiveness to inform screening policy decisions. The secondary outcome evaluated the possible screening barriers in the adoption of bowel screening of first-degree relatives. Data presented suggests that screening first-degree relatives of patients with bowel cancer is likely to be cost effective to the NHS, and that compared with the average-risk group using colonoscopy, advanced neoplasia was significantly more prevalent in those with first-degree relatives with bowel cancer. Targeted screening would mean less long-term health costs however, given the limited resources on NHS cost analysis data, cost savings associated with targeted screening are largely unknown; although data presented from European studies strongly suggests that it may be optimistic. Opportunities for this review include its recommendation to modify the screening criteria to extend to first-degree relatives of bowel cancer patients and for the National Screening Committee to implement this protocol nationwide.