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Davies EA, Wang YH. Understanding inequalities in breast cancer screening uptake. BMJ 2023; 382:2084. [PMID: 37734765 DOI: 10.1136/bmj.p2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Elizabeth A Davies
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer, Society and Public Health, Comprehensive Cancer Centre, King's College London, UK
| | - Yueh-Hsin Wang
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer, Society and Public Health, Comprehensive Cancer Centre, King's College London, UK
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Abraham S, Foreman N, Sidat Z, Sandhu P, Marrone D, Headley C, Akroyd C, Nicholson S, Brown K, Thomas A, Howells LM, Walter HS. Inequalities in cancer screening, prevention and service engagement between UK ethnic minority groups. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S14-S24. [PMID: 35648663 DOI: 10.12968/bjon.2022.31.10.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
More people in the UK are living with cancer than ever before. With an increasingly ethnically diverse population, greater emphasis must be placed on understanding factors influencing cancer outcomes. This review seeks to explore UK-specific variations in engagement with cancer services in minority ethnic groups and describe successful interventions. The authors wish to highlight that, despite improvement to engagement and education strategies, inequalities still persist and work to improve cancer outcomes across our communities still needs to be prioritised. There are many reasons why cancer healthcare inequities exist for minority communities, reported on a spectrum ranging from cultural beliefs and awareness, through to racism. Strategies that successfully enhanced engagement included language support; culturally-sensitive reminders; community-based health workers and targeted outreach. Focusing on the diverse city of Leicester the authors describe how healthcare providers, researchers and community champions have worked collectively, delivering targeted community-based strategies to improve awareness and access to cancer services.
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Affiliation(s)
- Shalin Abraham
- F2 Academic Foundation Doctor, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Nalini Foreman
- Quality Assistant, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Zahirah Sidat
- Senior Research Practitioner, Hope Clinical Trials Facility, University Hospitals of Leicester NHS Trust, Leicester
| | - Pavandeep Sandhu
- Research Technician, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Domenic Marrone
- Research Technician, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Catherine Headley
- Senior Cancer Services Manager, Leicester City Clinical Commissioning Group, Leicester
| | - Carol Akroyd
- Collaboration for Leadership in Applied Health Research and Care Equality and Diversity Theme Manager, Centre for Ethnic Health Research, University of Leicester, Leicester
| | - Sarah Nicholson
- Hope Clinical Trials Facility Manager/Cancer, Haematology, Urology, Gastroenterology, General Surgery Research Lead, Hope Clinical Trials Facility, University Hospitals of Leicester NHS Trust, Leicester
| | - Karen Brown
- Professor in Translational Cancer Research, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Anne Thomas
- Professor of Cancer Therapeutics, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Lynne M Howells
- Experimental Cancer Medicine Centre Translational Research Manager, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Harriet S Walter
- Associate Professor of Medical Oncology, Leicester Cancer Research Centre, University of Leicester, Leicester
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Young B, Robb KA. Understanding patient factors to increase uptake of cancer screening: a review. Future Oncol 2021; 17:3757-3775. [PMID: 34378403 DOI: 10.2217/fon-2020-1078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Early detection of cancer through organized screening is a central component of population-level strategies to reduce cancer mortality. For screening programs to be effective, it is important that those invited to screening participate. However, uptake rates are suboptimal in many populations and vary between screening programs, indicating a complex combination of patient factors that require elucidation to develop evidence-based strategies to increase participation. In this review, the authors summarize individual-level (sociodemographic and psychosocial) factors associated with cancer screening uptake and evidence for the effectiveness of behavioral interventions to increase uptake. The authors reflect on current trends and future directions for behavioral cancer screening research to overcome challenges and address unmet needs in reducing cancer mortality.
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Affiliation(s)
- Ben Young
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
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Maroni R, Massat NJ, Parmar D, Dibden A, Cuzick J, Sasieni PD, Duffy SW. A case-control study to evaluate the impact of the breast screening programme on mortality in England. Br J Cancer 2021; 124:736-743. [PMID: 33223536 PMCID: PMC7884709 DOI: 10.1038/s41416-020-01163-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Over the past 30 years since the implementation of the National Health Service Breast Screening Programme, improvements in diagnostic techniques and treatments have led to the need for an up-to-date evaluation of its benefit on risk of death from breast cancer. An initial pilot case-control study in London indicated that attending mammography screening led to a mortality reduction of 39%. METHODS Based on the same study protocol, an England-wide study was set up. Women aged 47-89 years who died of primary breast cancer in 2010 or 2011 were selected as cases (8288 cases). When possible, two controls were selected per case (15,202 controls) and were matched by date of birth and screening area. RESULTS Conditional logistic regressions showed a 38% reduction in breast cancer mortality after correcting for self-selection bias (OR 0.62, 95% CI 0.56-0.69) for women being screened at least once. Secondary analyses by age group, and time between last screen and breast cancer diagnosis were also performed. CONCLUSIONS According to this England-wide case-control study, mammography screening still plays an important role in lowering the risk of dying from breast cancer. Women aged 65 or over see a stronger and longer lasting benefit of screening compared to younger women.
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Affiliation(s)
- Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Nathalie J Massat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Amanda Dibden
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Peter D Sasieni
- Faculty of Life Sciences and Medicine, Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Campus, Great Maze Pond, London, SE1 9RT, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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What can be done to encourage women from Black, Asian and minority ethnic backgrounds to attend breast screening? A qualitative synthesis of barriers and facilitators. Public Health 2021; 190:152-159. [PMID: 33419526 DOI: 10.1016/j.puhe.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of the study is to identify the barriers to UK Black, Asian and Minority Ethnic (BAME) women attending breast screening and subsequently, support the growing evidence base providing solutions to the public health problem of ethnic variation within screening attendance. STUDY DESIGN A systematic review and thematic analysis of UK-based, qualitative studies concerning BAME women. METHODS The methodology of this review is based on Cochrane guidelines. A search strategy was applied to Embase, PubMed and Medline. Predefined inclusion and exclusion criteria yielded 8 final articles which were appraised and thematically analysed. RESULTS The main findings of the review revealed three overarching themes: knowledge-related, access-related and cultural-related factors. The emphasis of the importance of knowledge was highlighted by all studies identifying a lack of knowledge as a key barrier to screening attendance. CONCLUSIONS BAME women have disproportionally lower breast screening attendance and a lack of knowledge is an essential barrier to overcome when addressing this health inequality.
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Shahim B, Hasselberg S, Boldt-Christmas O, Gyberg V, Mellbin L, Rydén L. Effectiveness of different outreach strategies to identify individuals at high risk of diabetes in a heterogeneous population: a study in the Swedish municipality of Södertälje. Eur J Prev Cardiol 2018; 25:1990-1999. [PMID: 30289273 DOI: 10.1177/2047487318805582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Identifying type 2 diabetes mellitus (T2DM) is a prerequisite for the institution of preventive measures to reduce future micro and macrovascular complications. Approximately 50% of people with T2DM are undiagnosed, challenging the assumption that a traditional primary healthcare setting is the most efficient way to reach people at risk of T2DM. A setting of this kind may be even more suboptimal when it comes to reaching immigrants, who often appear to have inferior access to healthcare and/or are less likely to attend routine health checks at primary healthcare centres. OBJECTIVES The objective of this study was to identify the best strategy to reach individuals at high risk of T2DM and thereby cardiovascular disease in a heterogeneous population. METHODS All 18-65-year-old inhabitants in the Swedish municipality of Södertälje ( n∼51,000) without known T2DM and cardiovascular disease were encouraged to complete the Finnish Diabetes Risk Score (FINDRISC: score > 15 indicating a high and > 20 a very high risk of future T2DM and cardiovascular disease) through the following communication channels: primary care centres, workplaces, Syrian orthodox churches, pharmacies, crowded public places, mass media, social media and mail. Data collection lasted for six weeks. RESULTS The highest response rate was obtained through workplaces (27%) and the largest proportion of respondents at high/very high risk through the Syrian orthodox churches (18%). The proportion reached through primary care centres was 4%, of whom 5% were at elevated risk. The cost of identifying a person at elevated risk through the Syrian orthodox church was €104 compared with €8 through workplaces and €112 through primary care centres. CONCLUSIONS The choice of communication channels was important to reach high/very high-risk individuals for T2DM and for screening costs. In this immigrant-dense community, primary care centres were inferior to strategies using workplaces and churches in terms of both the proportion of identified at-risk individuals and costs.
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Affiliation(s)
- Bahira Shahim
- 1 Department of Medicine Solna, Karolinska Institutet, Sweden
| | - Sofia Hasselberg
- 2 McKinsey & Company, Stockholm, Sweden.,3 Getinge AB, Gothenburg, Sweden
| | | | - Viveca Gyberg
- 1 Department of Medicine Solna, Karolinska Institutet, Sweden.,4 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Linda Mellbin
- 1 Department of Medicine Solna, Karolinska Institutet, Sweden
| | - Lars Rydén
- 1 Department of Medicine Solna, Karolinska Institutet, Sweden
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Allgood PC, Maroni R, Hudson S, Offman J, Turnbull AE, Peacock L, Steel J, Kirby G, Ingram CE, Somers J, Fuller C, Threlfall AG, Gabe R, Maxwell AJ, Patnick J, Duffy SW. Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial. Lancet Oncol 2017; 18:972-980. [PMID: 28522311 PMCID: PMC5489696 DOI: 10.1016/s1470-2045(17)30340-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP). METHODS In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM. FINDINGS We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%] of 13 247); relative risk of participation 1·81 (95% CI 1·70-1·93; p<0·0001). INTERPRETATION These findings show that a policy of second appointments with fixed date and time for non-attenders of breast screening is effective in improving participation. This strategy can be easily implemented by the screening sites and, if combined with simple interventions, could further increase participation and ensure an upward shift in the participation trend nationally. Whether the policy should vary by time since last attended screen will have to be considered. FUNDING National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.
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Affiliation(s)
- Prue C Allgood
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Judith Offman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne E Turnbull
- Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Southern Derbyshire Breast Screening Service, Derby, UK
| | - Lesley Peacock
- Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Humberside Breast Screening Service, Cottingham, UK
| | - Jim Steel
- Plymouth Hospitals NHS Trust, Derriford Hospital, Primrose Breast Care Centre, Plymouth, UK
| | - Geraldine Kirby
- South East London Breast Screening Programme, King's College Hospital NHS Foundation Trust, London, UK
| | - Christine E Ingram
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield Breast Screening Unit, Sheffield, UK
| | - Julie Somers
- West of London Breast Screening Service, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Clare Fuller
- West of London Breast Screening Service, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - Rhian Gabe
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
| | - Anthony J Maxwell
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Nightingale Centre, University Hospital of South Manchester, Manchester, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Duffy SW, Myles JP, Maroni R, Mohammad A. Rapid review of evaluation of interventions to improve participation in cancer screening services. J Med Screen 2016; 24:127-145. [PMID: 27754937 PMCID: PMC5542134 DOI: 10.1177/0969141316664757] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective Screening participation is spread differently across populations, according to factors such as ethnicity or socioeconomic status. We here review the current evidence on effects of interventions to improve cancer screening participation, focussing in particular on effects in underserved populations. Methods We selected studies to review based on their characteristics: focussing on population screening programmes, showing a quantitative estimate of the effect of the intervention, and published since 1990. To determine eligibility for our purposes, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search and expanded this until the search yielded eligible papers on title review which were less than 1% of the total. We classified the eligible studies by intervention type and by the cancer for which they screened, while looking to identify effects in any inequality dimension. Results The 68 papers included in our review reported on 71 intervention studies. Of the interventions, 58 had significant positive effects on increasing participation, with increase rates of the order of 2%–20% (in absolute terms). Conclusions Across different countries and health systems, a number of interventions were found more consistently to improve participation in cancer screening, including in underserved populations: pre-screening reminders, general practitioner endorsement, more personalized reminders for non-participants, and more acceptable screening tests in bowel and cervical screening.
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Affiliation(s)
- Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jonathan P Myles
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Abeera Mohammad
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Greenhough B, Dembinsky M, Dyck I, Brown T, Robson J, Homer K, Sajani C, Carter L, Duffy SW, Ornstein M. Evaluating a DVD promoting breast cancer awareness among black women aged 25-50 years in East London. J Epidemiol Community Health 2016; 70:678-82. [PMID: 26787203 DOI: 10.1136/jech-2015-206540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/22/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The mean age of presentation for breast cancer among black women is substantially earlier than their white counterparts. Black women also present with adverse prognostic factors that have major clinical implications, including lower survival. To pilot the use of a 6 min DVD on breast cancer in young (under 50 years) black women, to raise awareness and examine the impact of the DVD on increased consultation and referral rates among these women. METHODS Two general practices (intervention practices) in the Hackney area were randomised to have the DVD mailed to all black women aged 25-50 years registered with the practices, and two practices to no intervention (control practices). EMIS data was used to compare consultation rates preintervention and postintervention, in the intervention as well as control practices. Interviews with practice staff and focus groups with patients in participating practices provided qualitative data on the study context and DVD effectiveness. RESULTS A trend of declining consultations for breast symptoms was observed (-22% and -31% among non-black women in the control and intervention practices, and -23% among black women in the control practice) except among the target population of black women aged 25-50 years for the DVD in the intervention practices, which saw an increase of 28% in consultations. The qualitative data indicated that the DVD was well received in the target population, and suggested further ways of disseminating awareness messages and overcoming barriers to help-seeking. CONCLUSIONS Pilot results suggest that the strategy of distributing the DVD may increase consultations for breast problems.
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Affiliation(s)
| | | | - Isabel Dyck
- School of Geography, Queen Mary University of London, London, UK
| | - Tim Brown
- School of Geography, Queen Mary University of London, London, UK
| | - John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Cynthia Sajani
- Homerton University Hospital NHS Foundation Trust, London, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry Queen Mary University of London, London, UK
| | - Mark Ornstein
- Homerton University Hospital NHS Foundation Trust, London, UK
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McHugh SM, Tyrrell E, Johnson B, Healy O, Perry IJ, Normand C. Health workforce planning and service expansion during an economic crisis: A case study of the national breast screening programme in Ireland. Health Policy 2015; 119:1593-9. [PMID: 26421598 DOI: 10.1016/j.healthpol.2015.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/25/2022]
Abstract
This article aims to estimate the workforce and resource implications of the proposed age extension of the national breast screening programme, under the economic constraints of reduced health budgets and staffing levels in the Irish health system. Using a mixed method design, a purposive sample of 20 participants were interviewed and data were analysed thematically (June-September 2012). Quantitative data (programme-level activity data, screening activity, staffing levels and screening plans) were used to model potential workload and resource requirements. The analysis indicates that over 90% operational efficiency was achieved throughout the first six months of 2012. Accounting for maternity leave (10%) and sick leave (3.5%), 16.1 additional radiographers (whole time equivalent) would be required for the workload created by the age extension of the screening programme, at 90% operational efficiency. The results suggest that service expansion is possible with relatively minimal additional radiography resources if the efficiency of the skill mix and the use of equipment are improved. Investing in the appropriate skill mix should not be limited to clinical groups but should also include administrative staff to manage and support the service. Workload modelling may contribute to improved health workforce planning and service efficiency.
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Affiliation(s)
- S M McHugh
- Department of Epidemiology & Public Health, University College Cork, Ireland.
| | - E Tyrrell
- Centre of Health Policy and Management, Trinity College Dublin, Ireland
| | - B Johnson
- Centre of Health Policy and Management, Trinity College Dublin, Ireland
| | - O Healy
- Department of Public Health, Health Service Executive South, Cork, Ireland
| | - I J Perry
- Department of Epidemiology & Public Health, University College Cork, Ireland
| | - C Normand
- Centre of Health Policy and Management, Trinity College Dublin, Ireland
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Massat NJ, Douglas E, Waller J, Wardle J, Duffy SW. Variation in cervical and breast cancer screening coverage in England: a cross-sectional analysis to characterise districts with atypical behaviour. BMJ Open 2015; 5:e007735. [PMID: 26209119 PMCID: PMC4521532 DOI: 10.1136/bmjopen-2015-007735] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Reducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions where coverage is low. This study aimed to characterise districts with atypical coverage levels for cervical or breast screening. DESIGN Observational study of district-level coverage in the English Cervical and Breast screening programmes in 2012. SETTING England, UK. PARTICIPANTS All English women invited to participate in the cervical (age group 25-49 and 50-64) and breast (age group 50-64) screening programmes. OUTCOMES Risk adjustment models for coverage were developed based on district-level characteristics. Funnel plots of adjusted coverage were constructed, and atypical districts examined by correlation analysis. RESULTS Variability in coverage was primarily explained by population factors, whereas general practice characteristics had little independent effect. Deprivation and ethnicity other than white, Asian, black or mixed were independently associated with poorer coverage in both screening programmes, with ethnicity having the strongest effect; by comparison, the influence of Asian, black or mixed ethnic minority was limited. Deprivation, ethnicity and urbanisation largely accounted for the lower cervical screening coverage in London. However, for breast screening, being located in London remained a strong negative predictor. A subset of districts was identified as having atypical coverage across programmes. Correlates of deprivation in districts with relatively low adjusted coverage were substantially different from overall correlates of deprivation. DISCUSSION These results inform the continuing drive to reduce avoidable cancer deaths in England, and encourage implementation of targeted interventions in communities residing in districts identified as having atypically low coverage. Sequential implementation to monitor the impact of local interventions would help accrue evidence on 'what works'.
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Affiliation(s)
- Nathalie J Massat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Elaine Douglas
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Jo Waller
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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12
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Peckham S, Falconer J, Gillam S, Hann A, Kendall S, Nanchahal K, Ritchie B, Rogers R, Wallace A. The organisation and delivery of health improvement in general practice and primary care: a scoping study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Gillam
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Hann
- Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Kiran Nanchahal
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Benjamin Ritchie
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Rogers
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social Policy, University of Lincoln, Lincoln, UK
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Jack RH, Robson T, Davies EA. The varying influence of socioeconomic deprivation on breast cancer screening uptake in London. J Public Health (Oxf) 2015; 38:330-4. [PMID: 25829530 DOI: 10.1093/pubmed/fdv038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We assessed the relationship between screening uptake and socioeconomic deprivation for London women aged 50-52 invited to their first routine screening appointment between 2006 and 2009. METHODS We examined uptake for London overall and within six screening areas, using deprivation quintile, based on post code of residence. RESULTS After adjustment for age, area and ethnicity, overall uptake decreased with increasing deprivation (adjusted odds ratio (OR) = 0.95, P < 0.001). However, in two screening areas with lower uptake, women living in deprived areas had higher uptake than women from affluent areas. CONCLUSIONS These potential inequalities in early diagnosis across London require further investigation.
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Affiliation(s)
- Ruth H Jack
- Knowledge and Intelligence Team, Public Health England, London SE1 6LH, UK Cancer Epidemiology and Population Health, King's College London, London SE1 9RT, UK
| | - Tony Robson
- London Quality Assurance Reference Centre, London EC1A 7BE, UK
| | - Elizabeth A Davies
- Knowledge and Intelligence Team, Public Health England, London SE1 6LH, UK Cancer Epidemiology and Population Health, King's College London, London SE1 9RT, UK
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Offman J, Myles J, Ariyanayagam S, Colorado Z, Sharp M, Cruice M, North BV, Shiel S, Baker T, Jefferies R, Binysh K, Duffy SW. A telephone reminder intervention to improve breast screening information and access. Public Health 2014; 128:1017-22. [PMID: 25443131 DOI: 10.1016/j.puhe.2014.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 08/21/2014] [Accepted: 09/08/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In the UK, women aged 50-70 are offered breast cancer screening every three years. Screening participation rates in London have been particularly low. Low rates have been associated with low socio-economic status, and some ethnic groups have been observed to be underserved by cancer screening. This paper reports on a telephone reminder intervention in London Newham, an area of high deprivation and ethnic diversity. STUDY DESIGN Observational study of planned intervention. METHODS Women invited for breast screening were telephoned to confirm receipt of the invitation letter, remind invitees of their upcoming appointment, and to provide further information. Aggregate data at general practice level on invitation to and attendance at breast screening and on numbers reached by telephone were analysed by logistic regression. RESULTS For the 29 participating GP practices (10,928 invitees) overall uptake in 2010 was higher compared to the previous screening round in 2007 (67% vs. 51%; p < 0.001). On average 59% of invitees were reached by the reminder calls. A 10% increase in women reached resulted in an 8% increase in the odds of women attending their screening appointment (95% CI: 5%-11%), after adjusting for 2007 attendance rates. Practices with a higher proportion of South Asian women were associated with a larger uptake adjusted for 2007 uptake and population reached by the telephone intervention, (4% increase in odds of attendance per 10% increase in South Asian population, CI 1%-7%, p = 0.003) while practices with a higher proportion of black women were associated with a smaller uptake similarly adjusted. (11% decrease in odds of attendance per 10% increase in black population, CI 9%-16%, p < 0.001). CONCLUSIONS A language- and culture-sensitive programme of reminder calls substantially improved breast cancer screening uptake.
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Affiliation(s)
- J Offman
- Centre for Cancer Prevention, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - J Myles
- Centre for Cancer Prevention, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK.
| | - S Ariyanayagam
- NHS England Southside, 105 Victoria Street, London SW1E 6QT, UK
| | - Z Colorado
- Community Links, 105 Barking Road, Canning Town, London E16 4HQ, UK
| | - M Sharp
- Centre for Primary Care & Public Health, Blizard Institute, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK
| | - M Cruice
- NHS Commissioning Board London, 4th Floor, Drummond Street Wing, Stephenson House, 75 Hampstead Road, London NW1 2PL, UK
| | - B V North
- Centre for Cancer Prevention, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - S Shiel
- Central and East London Breast Screening Service, 3rd Floor, West Wing, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - T Baker
- Contracting and Quality Directorate, North and East London Commissioning Support Unit, Clifton House, 75-77 Worship Street, London EC2A 2DU, UK
| | - R Jefferies
- North and East London Commissioning Support Unit, Clifton House, 75-77 Worship Street, London EC2A 2DU, UK
| | - K Binysh
- Quality Assurance Reference Centre, Barts and the London NHS Trust, 1st Floor, 51/53 Bartholomew Close, West Smithfield, London EC1A 7BE, UK
| | - S W Duffy
- Centre for Cancer Prevention, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
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Jack RH, Møller H, Robson T, Davies EA. Breast cancer screening uptake among women from different ethnic groups in London: a population-based cohort study. BMJ Open 2014; 4:e005586. [PMID: 25324320 PMCID: PMC4202018 DOI: 10.1136/bmjopen-2014-005586] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To use newly available self-assigned ethnicity information to investigate variation in breast cancer screening uptake for women from the 16 specific ethnic groups within the broad Asian, Black and White groups that previous studies report. SETTING National cancer screening programme services within London. PARTICIPANTS 655,516 female residents aged 50-69, invited for screening between March 2006 and December 2009. Ethnicity information was available for 475,478 (72.5%). White British women were the largest group (306,689, 46.8%), followed by Indian (34,687, 5.3%), White Other (30,053, 4.6%), Black Caribbean (25,607, 3.9%), White Irish (17,271, 2.6%), Black African (17,071, 2.6%) and Asian Other (10,579, 1.6%). OUTCOME MEASURES Uptake for women in different ethnic groups aged 50-52 for a first call invitation to the programme, and for women aged 50-69 for a routine recall invitation after a previous mammography. Uptake is reported (1) for London overall, adjusted using logistic regression, for age at invitation, socioeconomic deprivation and geographical screening area, and (2) for individual areas, adjusted for age and deprivation. RESULTS White British women attended their first call (67%) and routine recall (78%) invitations most often. Indian women were more likely to attend their first (61%) or routine recall (74%) than Bangladeshi women (43% and 61%, respectively), and Black Caribbean women were more likely than Black African women to attend first call (63% vs 49%, respectively) and routine recall (74% vs 64%, respectively). There was less variation between ethnic groups in some screening areas. CONCLUSIONS Breast cancer screening uptake in London varies by specific ethnic group for first and subsequent invitations, with White British women being more likely to attend. The variation in the uptake for women from the same ethnic groups in different geographical areas suggests that collaboration about the successful engagement of services with different communities could improve uptake for all women.
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Affiliation(s)
- Ruth H Jack
- Public Health England, Knowledge and Intelligence Team, London, UK
- King's College London, Cancer Epidemiology and Population Health, London, UK
| | - Henrik Møller
- King's College London, Cancer Epidemiology and Population Health, London, UK
| | - Tony Robson
- London Quality Assurance Reference Centre, London, UK
| | - Elizabeth A Davies
- Public Health England, Knowledge and Intelligence Team, London, UK
- King's College London, Cancer Epidemiology and Population Health, London, UK
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Shankleman J, Massat NJ, Khagram L, Ariyanayagam S, Garner A, Khatoon S, Rainbow S, Rangrez S, Colorado Z, Hu W, Parmar D, Duffy SW. Evaluation of a service intervention to improve awareness and uptake of bowel cancer screening in ethnically-diverse areas. Br J Cancer 2014; 111:1440-7. [PMID: 24983374 PMCID: PMC4183836 DOI: 10.1038/bjc.2014.363] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/08/2014] [Accepted: 06/09/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Uptake of bowel cancer screening is lowest in London, in populations of lower socio-economic status, and in particular ethnic or religious groups. METHODS We report on the evaluation of two interventions to improve uptake in an area including populations of low socio-economic status and considerable ethnic diversity. The interventions were face-to-face health promotion on bowel cancer screening at invitees' general practice and health promotion delivered by telephone only. Nine large general practices in East London were chosen at random to offer face-to-face health promotion, and nine other large practices to offer telephone health promotion, with 24 practices of similar size as comparators. Data at practice level were analysed by Mann-Whitney-Wilcoxon tests and grouped-logistic regression. RESULTS There were 2034 invitees in the telephone intervention practices, 1852 in the face-to-face intervention practices and 5227 in the comparison practices. Median gFOBt kit uptake in the target population (aged 59-70) was 46.7% in the telephone practices, 43.8% in the face-to-face practices and 39.1% in the comparison practices. Significant improvements in the odds of uptake were observed following telephone intervention in both males (OR=1.39, 95% CI=1.20-1.61, P<0.001) and females (OR=1.49, 95% CI=1.29-1.73, P<0.001), while the face-to-face intervention mainly impacted uptake in males (OR=1.23, 95% CI=1.10-1.36), P<0.001) but did not lead to a significant increase in females (OR=1.12, 95% CI=0.96-1.29, P=0.2). CONCLUSIONS Personally delivered health promotion improved uptake of bowel cancer screening in areas of low socio-economic status and high ethnic diversity. The intervention by telephone appears to be the most effective method.
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Affiliation(s)
- J Shankleman
- Public Health, London Borough of Tower Hamlets, 4th Floor Mulberry Place, 5 Clove Crescent, London E14 1BY, UK
| | - N J Massat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - L Khagram
- NHS Bowel Cancer Screening Programme Newham, Tower Hamlets and City & Hackney Strategic Commissioning and Community Public Health Partnerships, 4th Floor Westside, Newham Dockside, 1000 Dockside Road, London E16 2QU, UK
| | - S Ariyanayagam
- NHS England, London Region, Southside, 105 Victoria Street, London SW1E 6QT, UK
| | - A Garner
- NHS City & Hackney Clinical Commissioning Group, Lawson practice, Nuttal Street, London N1 5HZ, UK
| | - S Khatoon
- NHS Newham Clinical Commissioning Group, Warehouse K, 2 Western Gateway, London E16 1DR, UK
| | - S Rainbow
- Bowel Cancer Screening Programme London Hub, North West London Hospitals NHS Trust, Watford Road, Harrow HA1 3UJ, UK
| | - S Rangrez
- North East London Bowel Cancer Screening Programme, Homerton University Hospital Trust, Homerton Row, London E9 6SR, UK
| | - Z Colorado
- Community Links Trust, 105 Barking Road, London E16 4HQ, UK
| | - W Hu
- Community Links Trust, 105 Barking Road, London E16 4HQ, UK
| | - D Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - S W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
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Vidal C, Garcia M, Benito L, Milà N, Binefa G, Moreno V. Use of text-message reminders to improve participation in a population-based breast cancer screening program. J Med Syst 2014; 38:118. [PMID: 25073694 DOI: 10.1007/s10916-014-0118-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/16/2014] [Indexed: 11/28/2022]
Abstract
To analyze the effect of a cell text message reminder service on participation in a mammogram screening program in Catalonia, Spain. A quasi-experimental design was used with women aged 50 to 69 years who had been scheduled mammogram appointments in June or July 2011. Women were personally invited by letter to attend to the breast cancer screening program (n = 12,786). Prior to the invitation, 3,719 (29.1 %) of them had provided their cell telephone number to the National Health Service. These women received a text message reminder 3 days before their scheduled appointment. Logistic regression models were used to analyze whether the text message reminder was associated with participation in screening. Cost-effectiveness of adding a text message reminder to the invitation letter was also analyzed. The overall rate of participation in breast cancer screening was 68.4 %. The participation rate was significantly higher in the text messaging group, with an age-adjusted OR of 1.56 (95 %CI: 1.43-1.70). A detailed analysis showed that the increase in participation related to the text message reminder was higher among women without previous screening who lived in areas where access to postal mail was limited (OR=2.85; 95 %CI: 2.31-3.53) compared to those who lived in areas of easier postal mail access (OR=1.66; 95 %CI: 1.36-2.02). The invitation letter+text message reminder was a cost-effective strategy. Text message reminders are an efficient cost-effective approach to improve participation in difficult-to-reach populations, such as rural areas and newly developed suburbs.
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Affiliation(s)
- C Vidal
- Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, Av. Gran Via 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
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18
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Coyle C, Kinnear H, Rosato M, Mairs A, Hall C, O’Reilly D. Do women who intermittently attend breast screening differ from those who attend every invitation and those who never attend? J Med Screen 2014; 21:98-103. [DOI: 10.1177/0969141314533677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Analysis of screening uptake usually dichotomizes women into attenders and non-attenders, though many women respond positively to some but not all invitations. This paper studies these intermittent attenders. Methods A cohort of 8,571 women invited for consecutive breast screens in the Northern Ireland Breast Screening Programme were followed in a study linking screening and census records. Multivariate logistic analysis was used to analyze the characteristics of those who attended both times (consistent), once (intermittent or ‘one-time only’), or not at all (non-attenders). Results Overall, 15.5% of women attended once and 13.4% were non-attenders. Non-attenders were characteristically disadvantaged (as measured by social renting, car access, and employment status), less likely to be married, and more likely to be healthy. One-time attenders were younger, and suffering poor health, though there was no association with either social renting or employment status. Privately rented accommodation and city living was associated with both one-time attendance and non-attendance. Conclusions One-time attenders are an important and distinct subgroup of screening invitees in this analysis. Their distinct characteristics suggest that transitory factors, such as change in marital status, ill-health, or addressing difficulties through change of residence are important. These distinct characteristics suggest the need for different approaches to increase attendance, among both intermittent attenders and those not attending at all.
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Affiliation(s)
- C Coyle
- Registrar in Public Health, Public Health Agency, Belfast
| | - H Kinnear
- Post Doctoral Research Fellow, Centre for Public Health, Queen's University Belfast
| | - M Rosato
- Senior Research Fellow; Bamford Centre for Mental Health and Wellbeing; University of Ulster; Northern Ireland
| | - A Mairs
- Director Breast Screening Service Northern Ireland, Public Health Agency, Belfast, Northern Ireland
| | - C Hall
- Information Officer, Quality Assurance Reference Centre, Public Health Agency, Belfast, Northern Ireland
| | - D O’Reilly
- Senior Lecturer, Centre for Public Health, Queen's University Belfast
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19
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O'Reilly D, Kinnear H, Rosato M, Mairs A, Hall C. Uptake of breast screening is influenced by current religion and religion of upbringing. JOURNAL OF RELIGION AND HEALTH 2013; 52:1168-1176. [PMID: 22113522 DOI: 10.1007/s10943-011-9556-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Research has shown that individuals with a current religious affiliation are more likely to use preventive health services. The aim of this study was to determine whether breast screening uptake in Northern Ireland is higher amongst women with a current affiliation to an organised religion and, for those with no current affiliation, to examine whether their religion of upbringing is associated with uptake of breast screening. The Northern Ireland Longitudinal Study (NILS) was used to link Census and national breast screening data for 37,211 women invited for routine breast screening between 2001 and 2004. Current religious affiliation, religion of upbringing and other demographic and socio-economic characteristics were as defined on the Census form. Multivariate logistic regression was used to determine the relationship between religion affiliation and attendance. Uptake of breast screening is about 25% lower for those without a current religious affiliation. There are modest differences between Catholics and Protestants, with the latter about 11% more likely to attend for screening. For those with no current religion, the religion of upbringing appears to positively influence attendance rates. These differences remain after adjustment for all of the socio-demographic and socio-economic factors that have been shown to influence uptake rates of breast screening in the UK to date. Record linkage is an efficient way to examine equity across demographic characteristics that are not routinely available. The lower uptake amongst those with no religious affiliation may mean that screening services may find it difficult to maintain or improve uptake rate in an increasingly secularised society.
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Affiliation(s)
- Dermot O'Reilly
- Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK
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20
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Abstract
Since the mid-90s UK governments and other policy makers have sought to develop policy that addresses the need for improved outcomes for people diagnosed with cancer. However, the strategies for cancer in Scotland, Wales and Northern Ireland are different to the policy on cancer produced under the English government. This article will examine policy developments in the English health service aimed at achieving early diagnosis of cancer with particular reference to the Cancer Reform Strategy (2007). The role of socioeconomic factors and the need for policy to address a range of cancers due to their differences in pathology and therefore diagnosis and treatment will also be considered.
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21
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Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer 2013; 108:2205-40. [PMID: 23744281 PMCID: PMC3693450 DOI: 10.1038/bjc.2013.177] [Citation(s) in RCA: 622] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- M G Marmot
- UCL Department of Epidemiology and Public Health, UCL Institute of Health Equity, 1-19 Torrington Place, London WC1E 7HB,
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22
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Davies EA, Renshaw C, Dixon S, Møller H, Coupland VH. Socioeconomic and ethnic inequalities in screen-detected breast cancer in London. J Public Health (Oxf) 2013; 35:607-15. [DOI: 10.1093/pubmed/fdt002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Logan RFA, Patnick J, Nickerson C, Coleman L, Rutter MD, von Wagner C. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut 2012; 61:1439-46. [PMID: 22156981 PMCID: PMC3437782 DOI: 10.1136/gutjnl-2011-300843] [Citation(s) in RCA: 374] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The Bowel Cancer Screening Programme in England began operating in 2006 with the aim of full roll out across England by December 2009. Subjects aged 60-69 are being invited to complete three guaiac faecal occult blood tests (6 windows) every 2 years. The programme aims to reduce mortality from colorectal cancer by 16% in those invited for screening. METHODS All subjects eligible for screening in the National Health Service in England are included on one database, which is populated from National Health Service registration data covering about 98% of the population of England. This analysis is only of subjects invited to participate in the first (prevalent) round of screening. RESULTS By October 2008 almost 2.1 million had been invited to participate, with tests being returned by 49.6% of men and 54.4% of women invited. Uptake ranged between 55-60% across the four provincial hubs which administer the programme but was lower in the London hub (40%). Of the 1.08 million returning tests 2.5% of men and 1.5% of women had an abnormal test. 17,518 (10,608 M, 6910 F) underwent investigation, with 98% having a colonoscopy as their first investigation. Cancer (n=1772) and higher risk adenomas (n=6543) were found in 11.6% and 43% of men and 7.8% and 29% of women investigated, respectively. 71% of cancers were 'early' (10% polyp cancer, 32% Dukes A, 30% Dukes B) and 77% were left-sided (29% rectal, 45% sigmoid) with only 14% being right-sided compared with expected figures of 67% and 24% for left and right side from UK cancer registration. CONCLUSION In this first round of screening in England uptake and fecal occult blood test positivity was in line with that from the pilot and the original European trials. Although there was the expected improvement in cancer stage at diagnosis, the proportion with left-sided cancers was higher than expected.
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Affiliation(s)
- Richard F A Logan
- Division of Epidemiology and Public Health, University of Nottingham Medical School, Nottingham NG7 2UH, UK.
| | | | | | | | - Matt D Rutter
- Tees Bowel Cancer Screening Centre, University Hospital of North Tees, Stockton-on-Tees,UK
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
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Socioeconomic variation in uptake of colonoscopy following a positive faecal occult blood test result: a retrospective analysis of the NHS Bowel Cancer Screening Programme. Br J Cancer 2012; 107:765-71. [PMID: 22864455 PMCID: PMC3425978 DOI: 10.1038/bjc.2012.303] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Bowel cancer is a serious health burden and its early diagnosis improves survival. The Bowel Cancer Screening Programme (BCSP) in England screens with the Faecal Occult Blood test (FOBt), followed by colonoscopy for individuals with a positive test result. Socioeconomic inequalities have been demonstrated for FOBt uptake, but it is not known whether they persist at the next stage of the screening pathway. The aim of this study was to assess the association between colonoscopy uptake and area socioeconomic deprivation, controlling for individual age and sex, and area ethnic diversity, population density, poor self-assessed health, and region. Methods: Logistic regression analysis of colonoscopy uptake using BCSP data for England between 2006 and 2009 for 24 180 adults aged between 60 and 69 years. Results: Overall colonoscopy uptake was 88.4%. Statistically significant variation in uptake is found between quintiles of area deprivation (ranging from 86.4 to 89.5%), as well as age and sex groups (87.9–89.1%), quintiles of poor self-assessed health (87.5–89.5%), non-white ethnicity (84.6–90.6%) and population density (87.9–89.3%), and geographical regions (86.4–90%). Conclusion: Colonoscopy uptake is high. The variation in uptake by socioeconomic deprivation is small, as is variation by subgroups of age and sex, poor self-assessed health, ethnic diversity, population density, and region.
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Bansal N, Bhopal RS, Steiner MFC, Brewster DH. Major ethnic group differences in breast cancer screening uptake in Scotland are not extinguished by adjustment for indices of geographical residence, area deprivation, long-term illness and education. Br J Cancer 2012; 106:1361-6. [PMID: 22415231 PMCID: PMC3326672 DOI: 10.1038/bjc.2012.83] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Breast cancer screening data generally show lower uptake in minority ethnic groups. We investigated whether such variations occur in Scotland. Methods: Using non-disclosive computerised linkage we combined Scottish breast screening and Census 2001 data. Non-attendance at first breast-screening invitation (2002–2008) was compared between 11 ethnic groups using age-adjusted risk ratios (RR) with 95% confidence intervals (CI), multiplied by 100, using Poisson regression. Results: Compared with the White Scottish (RR=100), non-attendance was similar for Other White British (99.5, 95% CI 96.1–103.2) and Chinese (112.8, 95% CI 96.3–132.2) and higher for Pakistani (181.7, 95% CI 164.9–200.2), African (162.2, 95% CI 130.8–201.1), Other South Asian (151.7, 95% CI 118.9–193.7) and Indian (141.7, 95% CI 121.1–165.7) groups. Adjustment for rural vs urban residence, long-term illness, area deprivation and education, associated with risk of non-attendance, increased the RR for non-attendance except for Pakistani women where it was modestly attenuated (RR=164.9, 149.4–182.1). Conclusion: Our data show important inequality in breast cancer screening uptake, not attenuated by potential confounding factors. Ethnic inequalities in breast screening attendance are of concern especially given evidence that the traditionally lower breast cancer rates in South Asian groups are converging towards the risks in the White UK population. Notwithstanding the forthcoming review of breast cancer screening, these data call for urgent action.
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Affiliation(s)
- N Bansal
- Edinburgh Ethnicity Health Research Group, Centre for Population Health Sciences, University of Edinburgh, UK.
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McKenzie F, Ives A, Jeffreys M. Socio-economic inequalities in survival from screen-detected breast cancer in South West England: population-based cohort study. Eur J Public Health 2011; 22:418-22. [DOI: 10.1093/eurpub/ckr107] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Kinnear H, Rosato M, Mairs A, Hall C, O'Reilly D. The low uptake of breast screening in cities is a major public health issue and may be due to organisational factors: a Census-based record linkage study. Breast 2011; 20:460-3. [PMID: 21600771 DOI: 10.1016/j.breast.2011.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/12/2011] [Accepted: 04/25/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Cancer screening uptake is generally lower in UK cities but quantifying city-level effects from causes due to population composition that comprise cities is hampered by data limitations. METHODS A unique data linkage project combining a 2001 Census-based longitudinal study in Northern Ireland with the NHS Breast Screening Program. Validated uptake in the three years following the Census for Belfast Metropolitan Urban Area was compared against the rest of the country with adjustment for cohort attributes defined at Census. RESULTS Belfast Metropolitan Urban Area contained 34.8% of invited women but a greater proportion who rented their accommodation (40.3%) or who did not have a car (47.1%). After full adjustment for demographic and socio-economic factors, Belfast Metropolitan Urban Area uptake was lower for first and subsequent screen (Odds ratio (OR) 0.72; 95% CIs 0.66, 0.78 and OR 0.58; 95% CIs 0.55, 0.62 respectively). There were no significant interactions between patient characteristics and area of residence indicating that all residents in Belfast Metropolitan Urban Area are equally affected. CONCLUSION The reduced uptake of screening in cities is a major public health issue; the effects are large and a large proportion of the population are affected, organisational factors appear to be the primary cause. Strategies to correct this imbalance might help reduce inequalities in health.
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Affiliation(s)
- H Kinnear
- Centre for Public Health, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland, UK.
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Baskaran V, Guergachi A, Bali RK, Naguib RNG. Predicting Breast Screening Attendance Using Machine Learning Techniques. ACTA ACUST UNITED AC 2011; 15:251-9. [DOI: 10.1109/titb.2010.2103954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kinnear H, Connolly S, Rosato M, Hall C, Mairs A, O'Reilly D. Are caregiving responsibilities associated with non-attendance at breast screening? BMC Public Health 2010; 10:749. [PMID: 21129196 PMCID: PMC3003649 DOI: 10.1186/1471-2458-10-749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 12/03/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research showed that deprived individuals are less likely to attend breast screening and those providing intense amounts of informal care tend to be more deprived than non-caregivers. The aim of this study was to examine the relationship between informal caregiving and uptake of breast screening and to determine if socio-economic gradients in screening attendance were explained by caregiving responsibilities. METHODS A database of breast screening histories was linked to the Northern Ireland Longitudinal Study, which links information from census, vital events and health registration datasets. The cohort included women aged 47 - 64 at the time of the census eligible for breast screening in a three-year follow-up period. Cohort attributes were recorded at the Census. Multivariate logistic regression was used to examine the relationship between informal caregiving and uptake of screening using STATA version 10. RESULTS 37,211 women were invited for breast screening of whom 27,909 (75%) attended; 23.9% of the cohort were caregivers. Caregivers providing <20 hours of care/week were more affluent, while those providing >50 hours/week were more deprived than non-caregivers. Deprived women were significantly less likely to attend breast screening; however, this was not explained by caregiving responsibilities as caregivers were as likely as non-caregivers to attend (Odds Ratio 0.97; 95% confidence intervals 0.88, 1.06). CONCLUSIONS While those providing the most significant amounts of care tended to be more deprived, caregiving responsibilities themselves did not explain the known socio-economic gradients in breast screening attendance. More work is required to identify why more deprived women are less likely to attend breast screening.
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Affiliation(s)
- Heather Kinnear
- Queen's University Belfast, Grosvenor Road, Belfast, Northern Ireland, UK.
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Davies EA, Linklater KM, Coupland VH, Renshaw C, Toy J, Park R, Petit J, Housden C, Møller H. Investigation of low 5-year relative survival for breast cancer in a London cancer network. Br J Cancer 2010; 103:1076-80. [PMID: 20736945 PMCID: PMC2965868 DOI: 10.1038/sj.bjc.6605857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 07/19/2010] [Accepted: 07/20/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Breast cancer 5-year relative survival is low in the North East London Cancer Network (NELCN). METHODS We compared breast cancer that was diagnosed during 2001-2005 with that in the rest of London. RESULTS North East London Cancer Network women more often lived in socioeconomic quintile 5 (42 vs 21%) and presented with advanced disease (11 vs 7%). Cox regression analysis showed the survival difference (hazard ratio: 1.27, 95% confidence interval (CI): 1.15-1.41) reduced to 1.00 (95% CI: 0.89-1.11) after adjustment for age, stage, socioeconomic deprivation, ethnicity and treatment. Major drivers were stage and deprivation. Excess mortality was in the first year. CONCLUSION Late diagnosis occurs in NELCN.
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Affiliation(s)
- E A Davies
- King's College London, Thames Cancer Registry, 1st floor, Capital House, 42 Weston Street, London, UK.
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Richards MA. The National Awareness and Early Diagnosis Initiative in England: assembling the evidence. Br J Cancer 2010; 101 Suppl 2:S1-4. [PMID: 19956152 PMCID: PMC2790704 DOI: 10.1038/sj.bjc.6605382] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A National Awareness and Early Diagnosis Initiative (NAEDI) has been established in England as part of the Government's strategy to improve cancer outcomes. One of the early priorities for this initiative has been to assemble the diverse evidence linking late diagnosis with poor survival and avoidable deaths. This supplement brings together new perspectives on existing research in this area together with findings from recently commissioned research. This paper describes a provisional model, the ‘NAEDI pathway’, for testing hypotheses relating to late diagnosis and its impact. Key findings from other papers in this supplement are also highlighted.
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Affiliation(s)
- M A Richards
- National Cancer Action Team, St Thomas' Hospital, Westminster Bridge Road, London, UK.
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Abstract
Achieving adequate levels of uptake in cancer screening requires a variety of approaches that need to be shaped by the characteristics of both the screening programme and the target population. Strategies to improve uptake typically produce only incremental increases. Accordingly, approaches that combine behavioural, organisational and other strategies are most likely to succeed. In conjunction with a focus on uptake, providers of screening services need to promote informed decision making among invitees. Addressing inequalities in uptake must remain a priority for screening programmes. Evidence informing strategies targeting low-uptake groups is scarce, and more research is needed in this area. Cancer screening has the potential to make a major contribution to early diagnosis initiatives in the United Kingdom, and will best be achieved through uptake strategies that emphasise wide coverage, informed choice and equitable distribution of cancer screening services.
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Affiliation(s)
- D P Weller
- Division of Community Health Sciences-General Practice, University of Edinburgh, 20 West Richmond St., Edinburgh, UK.
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