By Siu Hing ( Siu Hing ) Lo, on 12 May 2014
“Consistency is the last refuge of the unimaginative” – Oscar Wilde
Consistency may be the last refuge of the unimaginative, but the results of our latest study on participation in the NHS Bowel Cancer Screening Programme suggests it is important to cancer outcomes.
In England, all adults aged 60 to 74 are invited every other year for bowel cancer screening using a guaiac-based Faecal Occult Blood (gFOB) test. This is a home-based stool test that aims to detect tiny traces of blood in faeces. Those who test positive are offered a colonoscopy examination to look for bowel cancer and polyps. In a small minority of cases, a gFOB test yields an unclear result. The test will then need to be repeated once or twice.
In our study, we examined responses to three successive invitations using NHS records from the South of England. While over 70% participated at least once, only 44% participated all three times they were invited.
In line with expectations, individuals who did not respond to a previous invitation were less likely to respond to subsequent invitations. Most interestingly, however, our study also showed that the timing of non-response to invitations predicted subsequent response. Those who took part in the first round, but ‘dropped out’ in the second round were less likely to respond in the third round than those who skipped the first round and ‘entered late’ in the second round.
Another novel finding was that previous response to gFOB invitations predicts more than subsequent (single) gFOB screening. It also predicts compliance with colonoscopy examinations and completion of multiple gFOB tests if the results are unclear. Compliance with follow-up colonoscopies and multiple gFOB screening is particularly important because those who require these additional tests are at higher risk of bowel cancer.
The need for regular participation should therefore be emphasised in communications about bowel cancer to the public. Interventions and screening service improvements should also aim to increase participation and compliance at all stages of the bowel cancer screening process among those identified to be ‘at-risk’ of non-participation.
Lo, S.H., Halloran, S., Snowball, J., Seaman, H., Wardle, J. & C. von Wagner (2014), Colorectal cancer screening uptake over three biennial invitation rounds in the English Bowel Cancer Screening Programme, Gut, Published Online First: 7th May 2014, doi:10.1136/gutjnl-2013-306144.