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Practice Comment

We must take action to address the barriers to bowel screening

  • Comment

Bowel screening uptake is low among BME groups and in poorer areas, so we must do more to engage with communities, says Deborah Alisna

Figures suggest that there is lower uptake of bowel screening among black and minority ethnic (BME) groups than the white-British population. As with any new national health initiative, initial uptake of screening is low in some areas of the UK in both pilots and actual programmes.

The national uptake target is 60%. Statistics from the Scottish programme, which targets people aged 50–74, have yet to be released but in the Scottish pilot there was only 30% uptake in deprived communities and a lower uptake among men. As screening continues to be rolled out in Scotland, both socio-economic and gender factors present particular challenges to health boards in meeting the national uptake target. 

While the roll-out of the Welsh programme (for those aged 60–69) is national, in England and Scotland screening is being introduced by health board or PCT area, with centres undertaking their own awareness-raising programmes. This enables publicity and activities to be tailored to specific communities according to, for example, ethnicity and socio-economic deprivation, which is likely to help increase uptake.

The benefits of screening are proportional to uptake. Norfolk and Norwich University Hospitals NHS Trust was one of the first to offer screening and has met the 60% national uptake target, but this figure is lower in the urban areas of Norfolk and higher in its rural communities.

Tower Hamlets PCT, City and Hackney Teaching PCT and Newham PCT in east London were also among the first to roll-out the screening. These are areas with large populations of Asian decent and,  less than one year after the programme,  uptake was around the 30% level.

Regular screening is known to reduce the risk of dying from bowel cancer by 16%. Screening has already reduced deaths in the UK and it is also having an impact on public attitudes towards the disease. In England, more than two years after screening was introduced, nearly 1.3 million self-testing   kits have been returned by eligible 60–69-year-olds, nearly 2,000 cancers have been detected and over 7,000 people have had polyps removed.

But more needs to be done to explain the benefits of bowel cancer screening to eligible participants and their families. Innovative ways of engaging with communities and groups with traditionally low participation, such as men or BME groups, are also needed. Best practice in achieving this needs to be shared among healthcare professionals.

Bowel Cancer UK is currently piloting a programme with England’s South Asian communities. It is conducting focus groups to establish appropriate bowel cancer messaging and developing a DVD that can be used as a health promotion tool.  

The charity will also be running training courses for non-specialist healthcare professionals and recruiting and training volunteers from within the community to raise awareness of bowel cancer. Results from the pilot will be shared with healthcare professionals in primary and acute care.

Participation rates should increase over time with greater awareness but it is also important to understand attitudes towards screening in all groups so that barriers to acceptance can be addressed.

Deborah Alsina, is a director of services and strategy, Bowel Cancer UK

  • Bowel Cancer UK is launching an awareness and fundraising campaign, Check It, to encourage people to take part in screening. Awareness-raising material is available for healthcare professionals. Click here or call 020 7381 9711 for more information.
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