Under-represented Groups

While the change from gFOBT to FIT has improved uptake, there are still specific groups that are under-represented.

Men

Men have a higher risk of developing bowel cancer but are less likely to participate in the bowel cancer screening programme.

Research into participation listed embarrassment, a loss of masculinity, limited engagement with health improvement programmes and the NHS, and feeling that it wasn’t relevant (if the individual felt fit and well) as barriers to participation.

Men were found to:

• Prefer simplified information and memorable slogans
• Feel that the test wasn’t relevant if bowel cancer symptom information was included with test
• Trust the opinions of their GP and wife/partner

Recommendations for encouraging engagement amongst men:

• High value is placed on primary care staff in informing decision-making, therefore GP endorsement and discussion, often opportunistically, is important
• It should be clearly communicated that men without symptoms are eligible to participate
• Men should be encouraged to talk about decision making with anyone that they feel comfortable with

Lower socio-economic status

Screening awareness and participation is higher in more affluent areas. Eligible people with lower socio-economic status are less likely to participate in bowel cancer screening across England, Wales and Scotland. In some areas uptake is 20% lower in the most deprived populations (52%) compared to the least deprived (73%).
It is believed that some of the reluctance to engage is due to low levels of education and limited health literacy alongside psychosocial elements such as pessimistic expectations (fatalistic attitudes towards cancer and distrust in the medical system) and a lack of social support.

Recommendations to support socioeconomic status:

• In 2016, research found that an enhanced reminder letter reduced the socioeconomic gradient in screening uptake
• GP endorsement also improved uptake across all groups

Ethnic Minority Communities

Ethnic minority communities have lower participation in the bowel cancer screening programme than that seen in white British adults. Health literacy is a factor, perpetuated by potential language barriers. This is in addition to barriers faced by all eligible participants, such as embarrassment.
Research also found that non-white people were less likely to be aware that a national bowel cancer screening programme exists – with Afro-Caribbean and Somali adults being less likely to know there is a screening programme.

A key factor is community engagement.

Where possible, practices should engage with local organisations, community centres, pharmacies and support groups to raise awareness of screening and champion open discussion – this can also support understanding in culturally and linguistically appropriate environments.

INTERVIEW?

Note: Face-to-face and telephone interventions promoted uptake in both ethnically diverse and low socio-economic status groups.

Additional resources

Link: PWE-136 Bowel Cancer Screening Non-Responders: What can be done to increase uptake in men from lower socioeconomic groups?, BMJ journals: Guts (2016)
Link: Slow on the uptake? Encouraging male participation in the NHS bowel cancer screening programme, Mens Health Forum (2011)
Link: Decomposing socio-economic inequality in colorectal cancer screening uptake in England, Social Science & Medicine (2015)
Link: Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme, Lancet (2016)
Link: Evaluation of a service intervention to improve awareness and uptake of bowel cancer screening in ethnically-diverse areas, British Journal of Cancer (2014)
Link: Attitudes to colorectal cancer screen amongst ethnic minority groups in the UK, BMC Public Health (2008)
Link: Inequalities in participation in an organised national colorectal screening programme: results from the first 2.6 million invitations in England, International Journal of Epidemiology (2011)
Link: Ethnic inequalities in older adults bowel cancer awareness: findings from a community survey conducted in an ethnically diverse region in England, BMC Public Health (2021)