Do the UK public realise that colorectal cancer is a common cancer?

Combined patterns of participation in cervical, breast, and colorectal cancer screenings and factors for non-participation in each screening among women in Japan

Finding effective strategies to increase participation in cervical cancer screening (CCS), breast cancer screening (BCS) and colorectal cancer screening (CRCS) for women is an important public health issue. Our objective was to examine combined patterns of participation in these three screenings and investigate the factors associated with non-participation in each. We analyzed 115,254 women aged 40-69 who were age-eligible for all three screenings from a 2016 nationally representative cross-sectional survey in Japan. Eight screening patterns were defined as full-participation (CCS + BCS + CRCS), partial-participation (CCS + BCS, CCS + CRCS, BCS + CRCS, CCS, BCS, CRCS), and non-participation (none). Multinomial logistic regression analysis adjusted for age, marital status, educational attainment, employment status, self-rated health, current hospital visits, and smoking status was performed to evaluate the factors associated with each screening pattern, using full-participation as the reference category. Screening rates for cervical, breast, and colorectal cancer were 45.0%, 46.2%, and 40.4%, respectively. Although only 26.9% of women participated in all three screenings, more than 60% participated in at least one screening. Unstable employment, low educational attainment, low self-rated health, and current smoker were associated with both non-participation and partial-participation, especially single-participation in cervical and breast cancer screening. For example, self-employed women were more likely to be non-participants [aOR 2.80 95%CI: 2.65-2.96], single-participants for CCS [aOR 2.87 95%CI: 2.57-3.20], and BCS [aOR 2.07 95%CI: 1.85-2.33] than permanent workers. It may be useful to consider related factors for non-participation patterns to encourage partial-participants to have other cancer screenings by utilizing one cancer screening as an opportunity to provide information about other screenings.

Using Specialist Screening Practitioners (SSPs) to increase uptake of the Bowel Scope (Flexible Sigmoidoscopy) Screening Programme: a study protocol for a feasibility single-stage phase II trial

Background

The NHS Bowel Scope Screening (BSS) programme offers men and women aged 55 years a once-only flexible sigmoidoscopy (FS), a test that can help reduce colorectal cancer (CRC) incidence and mortality. However, the benefits of BSS are contingent on uptake. This National Institute for Health Research-funded single-stage phase II trial will test the feasibility of using patient navigation (PN), an intervention that offers support to patients to overcome barriers to healthcare, to increase BSS uptake within a socially deprived area of England.

Methods/design

All individuals invited for BSS at South Tyneside NHS Foundation Trust during the 6-month recruitment period will be invited to take part in the study. Consenting participants will be randomised to receive PN or usual care in a 2:1 ratio. PN involves non-attenders receiving a phone call from a Specialist Screening Practitioner (SSP) who will elicit reasons for non-attendance and offer educational, practical, and emotional support as needed. If requested by the patient, another appointment for BSS will then be arranged. We anticipate 30 % of participants will be non-attenders. Using A’Hern single-stage design, with 20 % significance level and 80 % power, at least 35 participants who receive PN need to subsequently attend for PN to be considered worthy of further investigation in a definitive trial. The primary outcome measure will be the number of participants in the PN group who re-book and attend their BSS appointment. A qualitative analysis of the PN transcripts, and interviews with the SSPs, will also be conducted, alongside a quantitative analysis of completed patient-reported experience questionnaires. An economic analysis will calculate the costs of delivering PN.

Discussion

This feasibility study will be instrumental in deciding whether to conduct the first definitive trial of PN in BSS in England. If PN is subsequently shown to be cost-effective at increasing uptake of BSS, NHS policies could be modified to implement PN as a standard service. The results will be disseminated in peer-reviewed journals and at scientific conferences.

Trial registration

International Standard Randomised Controlled Trial Number, ISRCTN13314752

Electronic supplementary material

The online version of this article (doi:10.1186/s40814-016-0093-8) contains supplementary material, which is available to authorized users.

Social Cognitive Mediators of Sociodemographic Differences in Colorectal Cancer Screening Uptake

Background. This study examined if and how sociodemographic differences in colorectal cancer (CRC) screening uptake can be explained by social cognitive factors. Methods. Face-to-face interviews were conducted with individuals aged 60–70 years (n = 1309) living in England as part of a population-based omnibus survey. Results. There were differences in screening uptake by SES, marital status, ethnicity, and age but not by gender. Perceived barriers (stand. b = −0.40, p < 0.001), social norms (stand. b = 0.33, p < 0.001), and screening knowledge (stand. b = 0.17, p < 0.001) had independent associations with uptake. SES differences in uptake were mediated through knowledge, social norms, and perceived barriers. Ethnic differences were mediated through knowledge. Differences in uptake by marital status were primarily mediated through social norms and to a lesser extent through knowledge. Age differences were largely unmediated, except for a small mediated effect via social norms. Conclusions. Sociodemographic differences in CRC screening uptake were largely mediated through social cognitive factors. Impact. Our findings suggest that multifaceted interventions might be needed to reduce socioeconomic inequalities. Ethnic differences might be reduced through improved screening knowledge. Normative interventions could emphasise screening as an activity endorsed by important others outside the immediate family to appeal to a wider audience.

Comparing barriers to colorectal cancer screening with barriers to breast and cervical screening: a population-based survey of screening-age women in Great Britain

Objective

Uptake of cancer screening tends to be lower for colorectal cancer (CRC) than cervical or breast cancer. Dislike of the test itself has often been identified as a barrier to CRC screening with the Faecal Occult Blood (FOB) test, but there have been no head-to-head comparisons of the three tests.

Methods

Women aged 50–80 ( n = 890) were recruited in spring 2012 as part of a population-based TNS Research International survey in Great Britain. Those in the eligible age range were asked if they had ever participated in breast, cervical or CRC screening. For each screening test, women who had never participated were asked for their ‘main reason’ using a checklist of barriers.

Results

Among eligible women, 67%, 83% and 90% reported ever having been screened for CRC, cervical and breast cancer respectively. More socioeconomically deprived women were less likely to report any screening, and single women were less likely to report CRC or breast screening than married women. Age was not associated with participation. Overall there were few differences between tests in the reported barriers, but dislike of the test was endorsed more often for CRC screening.

Conclusion

This was the first study to compare barriers to participation in organised screening programmes for CRC, breast and cervical cancer. Cancer screening tests share many barriers, but dislike of the test appears to be a stronger barrier to CRC screening. Women who are non-participants in more than one programme may have more global barriers to screening, such as cancer fatalism. The findings suggest that uptake of CRC screening could be improved by targeting the unpleasantness of stool sampling.

The impact of media coverage of the Flexible Sigmoidoscopy Trial on English colorectal screening uptake

Objective

To assess the impact of media coverage of the UK Flexible Sigmoidoscopy Trial on colorectal screening uptake in England.

Setting

In April 2010, publication of the UK Flexible Sigmoidoscopy (FS) Trial results generated considerable media interest in both FS and colorectal cancer (CRC) generally.

Methods

We used routinely collected data from the south of England (excluding London) to analyse return of faecal occult blood test (FOBt) kits within 28 days of the invitation (early uptake) among 60–69 year olds, before (T1, n = 31,229), around the time of (T2, n = 39,571), and one month after (T3, n = 33,430) the FS publicity.

Results

FOBt uptake over the whole period was 58.2%, with 38.4% of the kits returned within 28 days (early uptake). Across the three time periods, early uptake was 35.8% at T1, 39.4% at T2, and 39.7% at T3. Multivariate regression controlling for age, gender and socioeconomic status confirmed that uptake was higher if people received the FOBt kit around the time of the media coverage (T2: odds ratio [OR] = 1.17, 95% CI = 1.13–1.20), or one month after (T3: OR = 1.18, 95% CI = 1.15–1.22) than before (T1). Sub-group analyses demonstrated that the impact was stronger among previous non-responders than among first-time invitees or previous responders (P < 0.001).

Conclusion

Media coverage of the FS Trial appeared to have a small but positive impact on FOBt screening uptake, especially among people who had previously abstained from screening.

Do the British public recognise differences in survival between three common cancers?

BACKGROUND

The recognition that cancer is not a single entity, rather that different cancers have different causes and trajectories, has been a key development in the scientific understanding of cancer. However, little is known about the British public's awareness of differences between cancers. This study examined differences in perceived survivability for three common cancers with widely disparate survival rates (breast, colorectal and lung).

METHOD

In a population-based survey, using home interviews (N=2018), respondents answered a quantitative (numeric) question on 5-year survival and a qualitative (non-numeric) question on curability, for each of the three cancers.

RESULTS

British adults correctly recognised that 5-year survival for breast cancer was higher than for colorectal cancer (CRC), which in turn was recognised to be higher than for lung cancer. Similarly, curability was perceived to be higher for breast than CRC, and both were perceived to be more curable than lung cancer. Awareness of survival differences did not vary by sex, age or socioeconomic status. In terms of absolute values, there was a tendency to underestimate breast cancer survival and overestimate lung cancer survival.

CONCLUSION

The British public appear to be aware that not all cancers are equally fatal.