Colorectal cancer screening uptake over three biennial invitation rounds in the English bowel cancer screening programme

Abstract

ObjectiveTo examine patterns of colorectal cancer (CRC) screening uptake over three biennial invitation rounds in the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP) in England.MethodsWe analysed data from the BCSP's Southern Hub for individuals (n=62 099) aged 60–64 years at the time of first invitation to screening with a follow-up period that allowed for two further biennial invitations. Data on sex, age and a neighbourhood-level measure of socioeconomic deprivation were used in the analysis. Outcomes included uptake of guaiac-based faecal occult blood (gFOB) test screening, inadequate gFOB screening (≥1 test kit(s) returned but failed to complete further gFOB tests needed to reach a conclusive test result), test positivity, compliance with follow-up examinations (usually colonoscopy) and diagnostic outcomes.ResultsOverall gFOB uptake was 57.4% in the first, 60.9% in the second and 66.2% in third biennial invitation round. This resulted in 70.1% of the initial cohort having responded at least once, 60.7% at least twice and 44.4% three times. Participation in the first round was strongly predictive of participation in the second round (‘Previous Responders’: 86.6% vs ‘Previous Non-Responders’: 23.1%). Participation in the third round was highest among ‘Consistent Screeners’ (94.5%), followed by ‘Late Entrants’ (78.0%), ‘Dropouts’ (59.8%) and ‘Consistent Non-Responders’ (14.6%). Socioeconomic inequalities in uptake were observed across the three rounds, but sex inequalities decreased over rounds. Inadequate gFOB screening was influenced by screening history and socioeconomic deprivation. Screening history was the only significant predictor of follow-up compliance.ConclusionsScreening history is associated with overall gFOB uptake, inadequate gFOB screening and follow-up compliance. Socioeconomic deprivation is also consistently associated with lower gFOB uptake and inadequate gFOB screening. Improving regular screening among identified ‘at-risk’ groups is important for the effectiveness of CRC screening programmes.

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

“…Uptake of screening was higher in our sample (61.0%) than in other studies (von Wagner, Baio, et al, 2011), probably because the age profile meant that the older participants were likely to have been invited over two or more rounds which, as reported recently, can increase uptake (Lo et al, 2014). A recent study using ELSA data, but including a broader age range, found a 57% uptake of screening (Gale, Deary, Wardle, Zaninotto, & Batty, 2015).…”

“…The upper age limit is currently being extended to 75. Overall uptake is approximately 54% (von Wagner, Baio, et al, 2011), although rates are higher when several screening rounds are included (Lo et al, 2014). There is evidence of substantial variation in uptake by socio-economic status, with one study finding participation in the most deprived quintile of residential areas to be only 35%, compared with 61% in the least deprived quintile (von Wagner, Baio, et al, 2011).…”

Home-use faecal immunochemical testing: primary care diagnostic technology update

“…1 Those who attend screening have a 25% reduction (RR 0.75, CI = 0.66 to 0.84) in their risk of death, but only 40% return all three BCSP gFOB kits, although involving GPs in screening increases uptake. 1,2 Faecal immunochemical testing (FIT) measures the globin component of human haemoglobin. Unlike gFOB, FIT does not require dietary restriction, is specific to lower gastrointestinal (GI) cancers as upper GI enzymes degrade human globin, and is less affected by concomitant medication use.…”

Health Economic Evaluations of Screening Programs - Applications and Method Improvements

“…These numbers were calculated based on the early experience in the SCREESCO-study and a study of repeated screening in the UK. [96] This means that these two subpopulations will never, respectively always, attend the screening, irrespective of the number of times they were invited to the screening. However, the attendance rate at consecutive invitation to screening was assumed to be the same as at the first invitation to screening.…”

“…However, the attendance rate at consecutive invitation to screening was assumed to be the same as at the first invitation to screening. [96,97] The specificity and sensitivity of OC were retrieved from a meta-analysis presented by Telford et al [98] and the corresponding parameters for FIT (cut-off value 10 µg) were obtained from Wijkerslooth et al…”