Inequalities in colorectal cancer screening participation in the first round of the national screening programme in England.
BACKGROUND
Introduction of organised, population-based, colorectal cancer screening in the United Kingdom using the faecal occult blood test (FOBT) has the potential to reduce overall colorectal cancer mortality. However, socio-economic variation in screening participation could exacerbate existing inequalities in mortality.


METHODS
This study examined FOBT uptake rates in London, England in relation to area-level socio-economic deprivation over the first 30 months of the programme during which 401 197 individuals were sent an FOBT kit. Uptake was defined as return of a completed test kit within 3 months. Area-level deprivation in each postcode sector was indexed with the Townsend Material Deprivation Index. Analyses controlled for area-level household mobility, ethnic diversity and poor health, each of which was associated with lower return rates.


RESULTS
The results showed a strong socio-economic gradient in FOBT uptake, which declined from 49% in the least deprived quintile of postcodes to 38% in the middle quintile and 32% in the most deprived quintile. Variation in socio-economic deprivation between sectors accounted for 62% of the variance in return rates, with little attenuation as a result of controlling for ethnic diversity, household mobility or health status.


CONCLUSIONS
These results highlight the need to understand the causes of socio-economic gradients in screening participation and address barriers that could otherwise increase disparities in colorectal cancer survival.
von Wagner
C
C
Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, Gower Street, London, UK. c.wagner@ucl.ac.uk
Good
A
A
Wright
D
D
Rachet
B
B
Obichere
A
A
Bloom
S
S
Wardle
J
J
D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D055088:Early Detection of Cancer; D004739:England; D006801:Humans; D008403:Mass Screening; D009780:Occult Blood; D012959:Socioeconomic Factors