Abstract

Background

The Bowel Cancer Screening Programme has demonstrated a reduction in mortality from colorectal cancer (CRC). West London is one of the most of the ethnically diverse populations within the United Kingdom, exhibiting some of the lowest compliance with the Bowel Cancer Screening Programme Nationally. This study aimed to evaluate the impact of ethnicity on the uptake of CRC screening in West London.

Method

A retrospective analysis was performed of all bowel cancer screening results from the CWHHE collaborative 5 Clinical Commissioning Groups between 2012-2017. All SystmOne GP practice data was collated and compliance with the Bowel Cancer Screening programme was analysed according to ethnicity as categorised according to the ‘2011 Census analysis in England and Wales: Ethnicity’. Logistic regression analysis was performed to assess the effect of ethnicity on compliance with the screening programme.

Results

A total of 155,038 individuals were invited to take part in the Bowel Cancer Screening Programme across 238 general practices. An overall compliance of 46.5% was demonstrated ranging from 41.7-49.9% across the 5 CCGs. A significantly lower compliance to FOB screening was demonstrated across ethnic groups compared to the ‘white’ group (Table 1).

Table 1- Logistic regression according to ethnicity

Ethnicity

Odds Ratio for compliance

P value

White

Reference Group

-

Asian- Bangladeshi

0.376

<0.0001

Asian- Indian

0.630

<0.0001

Asian- Pakistani

0.451

<0.0001

Asian-Chinese

1.007

0.894

Black African

0.653

<0.0001

Black Caribbean

0.884

<0.0001

Irish

0.945

0.053

Other Arab

0.699

<0.0001

Other Asian

0.759

<0.0001

Other Black

0.584

<0.0001

Other Ethnicity/Mixed

0.724

<0.0001

Other White

0.813

<0.0001

Conclusion

Significantly disproportionate uptake to CRC screening across ethnicities has a detrimental effect of furthering health inequity. Recognition of ethnicity as a barrier to CRC screening is imperative, with international consensus of ethnicity classification, and identification of vulnerable ethnic groups for focussed qualitative research and health promotion.