Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening

Citation

Raine R, Duffy SW, Wardle J, Solmi F, Morris S, Howe R, Kralj-Hans I, Snowball J, Counsell N, Moss S, Hackshaw A, von Wagner C, Vart G, McGregor LM & Smith SG (2016) Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening. British Journal of Cancer, 114, pp. 321-326. https://doi.org/10.1038/bjc.2015.413

Abstract
Background: There is a socioeconomic gradient in the uptake of screening in the English NHS Bowel Cancer Screening Programme (BCSP), potentially leading to inequalities in outcomes. We tested whether endorsement of bowel cancer screening by an individual’s general practice (GP endorsement; GPE) reduced this gradient. Methods: A cluster-randomised controlled trial. Over 20 days, individuals eligible for screening in England from 6480 participating general practices were randomly allocated to receive a GP-endorsed or the standard invitation letter. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation. Results: We enrolled 265 434 individuals. Uptake was 58.2% in the intervention arm and 57.5% in the control arm. After adjusting for age, sex, hub and screening episode, GPE increased the overall odds of uptake (OR=1.07, 95% CI 1.04–1.10), but did not affect its socioeconomic gradient. We estimated that implementing GPE could result in up to 165 more people with high or intermediate risk colorectal adenomas and 61 cancers detected, and a small one-off cost to modify the standard invitation (£78 000). Conclusions: Although GPE did not improve its socioeconomic gradient, it offers a low-cost approach to enhancing overall screening uptake within the NHS BCSP.

Keywords
cancer epidemiology; cancer screening; colorectal cancer; economics

Notes
Additional co-authors: Stephen Halloran, Graham Handley, Richard F Logan, Sandra Rainbow, Steve Smith, Mary C Thomas, Wendy Atkin

Journal
British Journal of Cancer: Volume 114

• Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening