Inequalities in colorectal cancer screening uptake in Wales: an examination of the impact of the temporary suspension of the screening programme during the COVID-19 pandemic

Abstract

Background Response to the early stages of the COVID-19 pandemic resulted in the temporary disruption of cancer screening in the UK, and strong public messaging to stay safe and to protect NHS capacity. Following reintroduction in services, we explored the impact on inequalities in uptake of the Bowel Screening Wales (BSW) programme to identify groups who may benefit from tailored interventions. Methods Records within the BSW were linked to electronic health records (EHR) and administrative data within the Secured Anonymised Information Linkage (SAIL) Databank. Ethnic group was obtained from a linked data method available within SAIL. We examined uptake for the first 3 months of invitations (August to October) following the reintroduction of BSW programme in 2020, compared to the same period in the preceding 3 years. Uptake was measured across a 6 month follow-up period. Logistic models were conducted to analyse variations in uptake by sex, age group, income deprivation quintile, urban/rural location, ethnic group, and clinically extremely vulnerable (CEV) status in each period; and to compare uptake within sociodemographic groups between different periods. Results Uptake during August to October 2020 (period 2020/21; 60.4%) declined compared to the same period in 2019/20 (62.7%) but remained above the 60% Welsh standard. Variation by sex, age, income deprivation, and ethnic groups was observed in all periods studied. Compared to the pre-pandemic period in 2019/20, uptake declined for most demographic groups, except for older individuals (70–74 years) and those in the most income deprived group. Uptake continues to be lower in males, younger individuals, people living in the most income deprived areas and those of Asian and unknown ethnic backgrounds. Conclusion Our findings are encouraging with overall uptake achieving the 60% Welsh standard during the first three months after the programme restarted in 2020 despite the disruption. Inequalities did not worsen after the programme resumed activities but variations in CRC screening in Wales associated with sex, age, deprivation and ethnic group remain. This needs to be considered in targeting strategies to improve uptake and informed choice in CRC screening to avoid exacerbating disparities in CRC outcomes as screening services recover from the pandemic.

Inequality in uptake of bowel cancer screening by deprivation, ethnicity and smoking status: cross-sectional study in 86 850 citizens

“…One study from Wales reported low uptake of bowel cancer screening by males, younger individuals and those living in areas of higher deprivation. 23 Uptake also varied according to ethnic group, with uptake lowest in those of Asian and Unknown ethnic background, though these findings were comparable before and after the suspension of services because of the COVID-19 pandemic. 23 …”

“… 23 Uptake also varied according to ethnic group, with uptake lowest in those of Asian and Unknown ethnic background, though these findings were comparable before and after the suspension of services because of the COVID-19 pandemic. 23 …”

“… 21 This is in keeping with findings of a recent Welsh study and may reflect the fact that the UK CRC screening is free and home-based and so common reasons for avoiding screening during the pandemic such as uneasiness about attending healthcare settings or using public transport did not apply. 23 …”

Noteworthy impacts of COVID-19 pandemic on cancer screening: A systematic review

“…Seven studies [ 31 , 32 , 36 , 39 , 58 , 65 , 74 ] scored 1 point because of statistical differences in the most or second-most important factors. Forty-five studies [ [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , 33 , 34 , 37 , 38 , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [53] , [54] , [55] , [56] , [57] , [59] , [60] , [61] , [62] , [63] , [64] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , 75 , 76 ] scored 0 point in view of the lack of control over the most or second-most important factors in the comparability domain.…”

Racial/ethnic and socioeconomic disparities in colorectal cancer screening in a large organization with universal insurance before and during the coronavirus disease 2019 pandemic

“…20–28 There are data accumulating to suggest that the effect of the COVID-19 pandemic has been more pronounced among subjects with low SES, minorities, and those in rural areas in many countries. 15,23,27,29–39 However, little is known about the impact of inequalities and the pandemic on CRC screening within an organization with universal health insurance.…”