title: The impact of age, sex and socioeconomic deprivation on outcomes in a colorectal cancer screening programme.
abstract: BACKGROUND
  Population-based colorectal cancer screening has been shown to reduce cancer specific mortality and is used across the UK. Despite evidence that older age, male sex and deprivation are associated with an increased incidence of colorectal cancer, uptake of bowel cancer screening varies across demographic groups. The aim of this study was to assess the impact of age, sex and deprivation on outcomes throughout the screening process.
  
  
  METHODS
  A prospectively maintained database, encompassing the first screening round of a faecal occult blood test screening programme in a single geographical area, was analysed.
  
  
  RESULTS
  Overall, 395,096 individuals were invited to screening, 204,139 (52%) participated and 6079 (3%) tested positive. Of the positive tests, 4625 (76%) attended for colonoscopy and cancer was detected in 396 individuals (9%). Lower uptake of screening was associated with younger age, male sex and deprivation (all p<0.001). Only deprivation was associated with failure to proceed to colonoscopy following a positive test (p<0.001). Despite higher positivity rates in those that were more deprived (p<0.001), the likelihood of detecting cancer in those attending for colonoscopy was lower (8% most deprived vs 10% least deprived, p = 0.003).
  
  
  CONCLUSIONS
  Individuals who are deprived are less likely to participate in screening, less likely to undergo colonoscopy and less likely to have cancer identified as a result of a positive test. Therefore, this study suggests that strategies aimed at improving participation of deprived individuals in colorectal cancer screening should be directed at all stages of the screening process and not just uptake of the test.
authors.affiliation: Academic Unit of Surgery, School of Medicine-University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom. David.Mansouri@glasgow.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Mansouri
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Grant
authors.forename: Emilia M
authors.initials: EM
authors.lastname: Crighton
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
mesh_terms: D000367:Age Factors; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D009780:Occult Blood; D011446:Prospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology