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BMJ. 2007 December 1; 335(7630): 1115.
PMCID: PMC2099524

Pilot of bowel cancer screening shows lower uptake in second round

A pilot project to test the acceptability of screening people for bowel cancer has shown a low uptake, with less than half of the men who were invited to take part doing so.

Uptake was also low in deprived areas and in some ethnic groups, says the report on the second round of the UK colorectal cancer screening pilot (British Journal of Cancer doi: 10.1038/sj.bjc.6604089). The first round of the pilot took place in 2000-3 in two sites, one in England and one in Scotland (BMJ 2004;329:133 doi: 10.1136/bmj.38153.491887.7C). Of those who were invited to take part in the second round 84% had taken part in the first.

The report also warns that screening will significantly increase the need for services, especially endoscopy.

“Our results suggest that ongoing effort will be required to minimise inequalities in uptake by targeting deprived and certain ethnic groups, and to ensure adequate capacity—particularly in the provision of endoscopy services,” write the authors.

The bowel cancer screening programme is being rolled out across the United Kingdom and is expected to be fully in place by 2009. The aim of the pilot scheme was to assess the feasibility of introducing screening that is based on faecal occult blood testing.

The authors of the new report, from Edinburgh University, the Institute of Cancer Research, Sutton, and other centres, looked at the second round of the pilot, which took place only at the English site.

A total of 127 746 men and women aged 50-69 years were invited to participate, of whom 66 264 (52%) returned an adequate test kit. Uptake in the first round was 59%. A total of 1171 people had a positive test result, of whom 970 attended for colonoscopy.

Uptake in men (48% of those invited) was lower than in women (56%) (adjusted odds ratio 1.42 (95% confidence interval 1.36 to 1.48)). Uptake, however, increased with age, from 46% in men and women aged under 55 to 59% in those aged 65-9.

Uptake also fell as level of deprivation increased, from 61% among participants in the wealthiest areas to 37% among those in the poorest, and was also lower in areas with a high proportion of people of Indian subcontinental origin (uptake 40%) than in areas with a low proportion (54%) (adjusted odds ratio 0.89 (0.86 to 0.93)).

The detection rate of cancer in the second round—0.9 cases per 1000 people invited for screening (95% confidence interval 0.7 to 1.2)—was lower than that in the first round (1.4 per 1000 (1.1 to 1.6)). The detection rate was higher in men (1.4 per 1000) than in women (0.5 per 1000) and increased with age. The results also show that 98 interval cancers occurred within two years of a negative screening result in the first round.

On the impact of screening on hospitals, the authors found no decline in the number of colonoscopies in the second round. They also found that screening activity in the two main hospitals involved in the pilot increased the overall workload of the departments concerned by about 14% and 28%, respectively.

“A key finding was the lower uptake of screening in the second round,” write the authors. “The reasons for this are unclear; recruitment strategies were similar in both rounds, although there was greater publicity when the pilot was launched, and this may have raised awareness.

They also say that ongoing participation may have been affected by the distasteful nature of the screening and the effort needed by participants and therefore that consideration should be given in the roll-out process to maintaining the public's interest and motivation, given that screening every two years is needed.

“The findings also reinforce the need to devise strategies to address low uptake in the subgroups which we identified,” the authors wrote. “It would appear that low levels of uptake persist beyond the first round of screening in more or less the same pattern, and this will be an important consideration in reducing health inequalities in colorectal cancer incidence and outcomes.”


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