Comparing uptake across breast, cervical and bowel screening at an individual level: a retrospective cohort study

Abstract

BackgroundWe investigated demographic and clinical predictors of lower participation in bowel screening relative to breast and cervical screening.MethodsData linkage study of routinely collected clinical data from 430,591 women registered with general practices in the Greater Glasgow & Clyde Health Board. Participation in the screening programmes was measured by attendance at breast or cervical screening or the return of a bowel screening kit.Results72.6% of 159,993 women invited attended breast screening, 80.7% of 309,899 women invited attended cervical screening and 61.7% of 180,408 women invited completed bowel screening. Of the 68,324 women invited to participate in all three screening programmes during the study period, 52.1% participated in all three while 7.2% participated in none. Women who participated in breast (OR = 3.34 (3.21, 3.47), p < 0.001) or cervical (OR = 3.48 (3.32, 3.65), p < 0.001) were more likely to participate in bowel screening.ConclusionParticipation in bowel screening was lower than breast or cervical for this population although the same demographic factors were associated with uptake, namely lower social deprivation, increasing age, low levels of comorbidity and prior non-malignant neoplasms. As women who complete breast and cervical are more likely to also complete bowel screening, interventions at these procedures to encourage bowel screening participation should be explored.

The integrated screening action model (I-SAM): A theory-based approach to inform intervention development

“…However, no matter how state-of-the-art the test, it will only be effective if people are willing to do it. Years of experience of cancer screening suggest that good uptake is hard to achieve, and our current approaches fail to engage the most vulnerable ( McCowan et al, 2019 ). The existing literature on screening behaviour while informed, in some cases, by theory, has not yet established a coherent action model of screening behaviour to guide our understanding of the determinants of screening behaviour and identify targets for intervention ( Rakowski and Breslau, 2004 , Kobrin et al, 2015 ).…”

“…Participation in screening programmes (breast, colorectal, cervical, lung, diabetic retinopathy, abdominal aortic aneurysm) remains suboptimal, with persistent inequalities in uptake such that people living in more socioeconomically deprived areas, ethnic minorities, people with comorbidities, and people with intellectual disabilities are less likely to participate ( Campbell et al, 2020 , McCowan et al, 2019 , Szczepura et al, 2008 , Crilly et al, 2015 , Leese et al, 2008 ). There is an urgent need to improve screening participation and develop effective interventions ( Duffy et al, 2017 ).…”

Why colorectal screening fails to achieve the uptake rates of breast and cervical cancer screening: a comparative qualitative study

“…This study was conducted alongside a quantitative study exploring cancer screening uptake among women living in Glasgow, Scotland 18. Data on screening participation for the breast, cervical and CRC screening programmes were linked for all women aged 20–74 (n=430 591) who were registered with NHS Greater Glasgow and Clyde Health Board and invited to screening during the period 2009–2013.…”

Including a general practice endorsement letter with the testing kit in the Bowel Cancer Screening Programme: Results of a cluster randomised trial

“…The programme has the lowest participation of the three cancer screening programmes, at around 60%, compared to participation rates of around 70% in screening programmes for breast cancer and 80% for those for cervical cancer. [2,3]. Participation is especially low in deprived populations, decreasing to 35% in the most deprived quintile of the population [2].…”