Comparison of breast and bowel cancer screening uptake patterns in a common cohort of South Asian women in England

Abstract

BackgroundInequalities in uptake of cancer screening by ethnic minority populations are well documented in a number of international studies. However, most studies to date have explored screening uptake for a single cancer only. This paper compares breast and bowel cancer screening uptake for a cohort of South Asian women invited to undertake both, and similarly investigates these women's breast cancer screening behaviour over a period of fifteen years.MethodsScreening data for rounds 1, 2 and 5 (1989-2004) of the NHS breast cancer screening programme and for round 1 of the NHS bowel screening pilot (2000-2002) were obtained for women aged 50-69 resident in the English bowel screening pilot site, Coventry and Warwickshire, who had been invited to undertake breast and bowel cancer screening in the period 2000-2002. Breast and bowel cancer screening uptake levels were calculated and compared using the chi-squared test.Results72,566 women were invited to breast and bowel cancer screening after exclusions. Of these, 3,539 were South Asian and 69,027 non-Asian; 18,730 had been invited to mammography over the previous fifteen years (rounds 1 to 5). South Asian women were significantly less likely to undertake both breast and bowel cancer screening; 29.9% (n = 1,057) compared to 59.4% (n = 40,969) for non-Asians (p < 0.001). Women in both groups who consistently chose to undertake breast cancer screening in rounds 1, 2 and 5 were more likely to complete round 1 bowel cancer screening. However, the likelihood of completion of bowel cancer screening was still significantly lower for South Asians; 49.5% vs. 82.3% for non-Asians, p < 0.001. South Asian women who undertook breast cancer screening in only one round were no more likely to complete bowel cancer screening than those who decided against breast cancer screening in all three rounds. In contrast, similar women in the non-Asian population had an increased likelihood of completing the new bowel cancer screening test. The likelihood of continued uptake of mammography after undertaking screening in round 1 differed between South Asian religio-linguistic groups. Noticeably, women in the Muslim population were less likely to continue to participate in mammography than those in other South Asian groups.ConclusionsCulturally appropriate targeted interventions are required to reduce observed disparities in cancer screening uptakes.

Attitudes of South Asian Women to Breast Health and Breast Cancer Screening: Findings from a Community Based Sample in the United States

“…Yet, utilization of breast cancer screening services is poor in South Asian women living in Asia (Maqsood et al, 2009;Bhatt et al, 2011;Grosse Frie et al, 2013), the US (Islam et al, 2006;Glenn et al, 2009;Lee et al, 2010) as well as other western countries (Sutton et al, 2001;Szczepura et al, 2008;Price et al, 2010;Rajan et al, 2011;Peltzer and Phaswana-Mafuya, 2014). Across the various studies among South Asians, the mammography rates range from 30-56%.…”

Population, Migration, Ageing and Health: A Survey

“…Women and undocumented migrants appear to face significant barriers. In particular, migrant and ethnic minority women are found to have difficulties in accessing prenatal care services, as well as cancer screenings (see e.g., Webb et al, 2004, Wolff et al, 2008, McCormack et al (2008, Moser et al (2009), Price et al, 2010. Similarly, the existing evidence indicates that migrants tend to over utilize emergency services compared to natives (see Dyhr et al, 2007 for Denmark andCots et al, 2007 for Spain).…”

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

“…70 Inequalities are also present in the longer-established UK breast and cervical screening programmes. 40,43,69,[71][72][73] Uptake across screening programmes has consistently been lower in London than in the rest of the country, and this has in part been attributed to its diverse population. [73][74][75] Many of the studies which have sought to explain reasons for ethnic disparities in screening uptake originate from the USA and present insights relating to black American, Hispanic, Latino and other ethnic groups.…”

“…40,43 A study of participation in bowel cancer screening using FS (an internal examination undertaken by a medical professional) similarly found lower uptake by South Asian participants after socioeconomic status had been controlled for. 70 Inequalities are also present in the longer-established UK breast and cervical screening programmes.…”

“…12,[40][41][42] Low uptake of colorectal cancer (CRC) screening in the UK has continued to be identified in areas with higher ethnic diversity, 5,12 and within all South Asian religiolinguistic groups even when age, deprivation and gender are adjusted for. 40,43 We therefore also explored culturally specific barriers to uptake in South Asian communities to identify additional appropriate methods which could be specifically targeted at minority ethnic groups who speak English. To do this, we carried out interviews with 16 participants acting as 'key informants' on behalf of their communities.…”