Incidence screening inequalities in the NHS Bowel Cancer Screening Programme


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Siu Hing Lo1, Christian von Wagner1, Julia Snowball2, Stephen Halloran2,3, Jane Wardle1
1University College London, London, UK, 2Bowel Cancer Screening Programme, Southern Hub, Royal Surrey County Hospital, Surrey, UK, 3University of Surrey, Surrey, UK

Background

In England, all age-eligible adults are invited for colorectal cancer screening using a Faecal Occult Blood (FOB) test every two years. Previous research has demonstrated gender and socioeconomic inequalities in uptake, but it is unclear if past screening participation moderates these effects.

Method

All individuals (n= 62,099) served by the Southern BCSP Hub, aged 60-64 at the time of first invitation (September 2006 - February 2008) were included in the dataset. Data from three rounds of screening invitations were analysed. Only individuals who had received an invitation to first incidence screening in round two (n= 34,871) and an invitation to second incidence screening in round three (n= 29,182) were included in the analysis. The dataset included information on the date individuals were sent invitations, the return date if they had completed a FOB test, gender, age and an area-level measure of socioeconomic deprivation (IMD score).

Results

Uptake was 87% for an invitation to first incidence screening in round two and 95% for an invitation to second incidence screening in round three. Socio-demographic differences in incidence screening were less marked than in prevalence screening. Women were marginally more likely to accept the invitation to first incidence screening (86.1% vs. 86.9%; OR= 1.07, 95% CI: 1.01-1.14) than men, but the gender effect was not significant for invitation to second incidence screening (94.4% vs. 94.6%; OR= 1.04, 95% CI: 0.94-1.15). Individuals from socioeconomically deprived areas were less likely to accept the invitation to first incidence screening (most affluent quintile: 88.4% vs. most deprived quintile: 82.9%; OR=0.90, 95% CI: 0.88-0.92) and the invitation to second incidence screening (95.6% vs. 92.6%; OR= 0.87, 95% CI: 0.84-0.91).

Conclusion

Uptake of incidence screening was high and increased with the number of consecutive previous screens. Small socioeconomic inequalities persisted in incidence screening, but gender differences were trivial.