Uptake of the English Bowel (Colorectal) Cancer Screening Programme: an update 5 years after the full roll-out

Yasemin Hirst, Sandro Stoffel, Gianluca Baio, Lesley McGregor, Christian von Wagner, Yasemin Hirst, Sandro Stoffel, Gianluca Baio, Lesley McGregor, Christian von Wagner

Abstract

Background: The initial roll-out of the English Bowel (Colorectal) Cancer Screening programme, during 2006 and 2009, found uptake to be low (54%) and socially graded. The current analysis used data from 2010 to 2015 to test whether uptake is increasing and becoming less socially graded over time.

Methods: Postcode-derived area-level uptake of 4.4 million first-time invitees, stratified by gender and the year of the first invitation (2010-2015), was generated using the National Bowel Cancer Screening System. Data were limited to people aged 60-64 years. Binomial regression tested for variations in uptake by the year of invitation, gender, region, area-based socio-economic deprivation and area-based ethnic diversity.

Results: Overall, the first-time colorectal cancer (CRC) screening uptake across 6 years was 52% (n = 2,285,996/4,423,734) with a decline between 2010 and 2015 (53%, 54%, 52%, 50%, 49%, 49% respectively). Uptake continued to be socially graded between the most and the least deprived area-level socio-economic deprivation quintiles (43% vs 57%), the most and the least area-based ethnic diversity quintiles (41% vs 56%) and men and women (47% vs 56%). Multivariate analysis demonstrated the effects of year, deprivation, ethnicity and gender on uptake. The effect of deprivation was more pronounced in the most deprived area quintile between men and women (40% vs 47%) than the least deprived area quintile (52% vs 62% respectively).

Conclusion: We did not find evidence of change in uptake patterns in CRC screening since its initial launch 10 years ago. The programme is unlikely to realise its full public health benefits and is en route to widening inequalities in CRC outcomes.

Keywords: Cancer screening uptake; Diffusion of innovation; Inequalities.

Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
gFOBT uptake as a function of deprivation and ethnic diversity. IMD, Index of Multiple Deprivation; gFOBT, guaiac-based faecal occult blood test.
Fig. 2
Fig. 2
Share of adequately screened (%) by the quintile of Index of Multiple Deprivation (IMD) score and geographic regions (2010–2015).
Fig. 3
Fig. 3
Estimated uptake over time (2010–2015). FOBT, faecal occult blood test.
Fig. 4
Fig. 4
Correlation between the percentage of abnormal test results and percentage of adequately screened. CI, confidence interval.

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