Location of Repository

Ethnicity : UK colorectal cancer screening pilot : final report

By Ala Szczepura, Mark R. D. Johnson, Sheina Orbell, Anil Gumber, I. O'Sullivan, Diane Clay, David Owen and HASH(0x56552a2b0ee8)


27. In summary, the overall evaluation of the UK Pilot has demonstrated that key parameters of test and programme performance observed in randomised studies of FOBt screening can be repeated in population-based pilot programmes. However, our study provides strong evidence of very low CRC screening uptake for ethnic groups in the Pilot area. This is coupled with a very low uptake of colonoscopy for individuals from ethnic groups with a positive FOBt result.\ud 28. It has long been acknowledged that a diverse population may require diverse responses. Following the implementation of the Race Relations Amendment Act 2000, there has been a statutory duty laid upon all NHS agencies to ‘have due regard to the need to eliminate unlawful discrimination’, and to make explicit consideration of the implications for racial equality of every action or policy.\ud 29. Because the observed overall outcomes in the UK Pilot generally compare favourably with the results of previous randomised trials of FOBt screening, the main Evaluation Group has concluded that benefits observed in the trials should be repeatable in a national roll-out.\ud 30. However, our study indicates that any national colorectal cancer screening programme would need to very carefully consider the implications of ethnicity for roll-out, and develop a strategic plan on how best to accommodate this at both a national and local level. Based on our findings, consideration will clearly need to be given to improved access and screening service provision for ethnic minorities.\ud 31. In order to ensure adequate CRC screening provision for a diverse UK population, and to address the explicit implications for racial equality highlighted by our findings, interventions now urgently need to be evaluated to improve access for ethnic minorities. This work should be undertaken as part of the second round of CRC screening currently underway in the English Pilot

Topics: RC0254, RA0421
Publisher: [Department of Health]
OAI identifier: oai:wrap.warwick.ac.uk:133

Suggested articles



  1. (1997). (v) Data on ethnic groups can be aggregated at various levels (Modood
  2. 0.187, ns Hindu-Gujerati Hindu-Other Muslim Sikh-Punjabi
  3. (1992). African Americans In the USA there has long been evidence of low levels of participation in FOBt screening by African Americans, especially older members of the population (Boring
  4. (1983). Protocol The survey protocol recommended by Dillman
  5. 4 A new version due for completion in 2003 will distinguish other groups e.g.
  6. A major evaluation of the Pilot was commissioned in 1999. The brief of the main Evaluation Group was to produce an independent report for the Department of Health on the outcomes of screening in the Pilot.
  7. (1991). Assessment of the psychological impact of a breast screening programme. doi
  8. (1991). CANCER SCREENING We identified only one UK evaluation of an intervention to improve uptake of cervical screening by ethnic minority women. This is a very early
  9. Cancer statistics for African Americans. doi
  10. (1991). Census data reveals that people from South Asian ethnic groups have a very strong tendency to cluster together, with marked geographical separation from other ethnic groups (Peach,
  11. (1991). Colorectal Cancer Screening Pilot are shown in Table 6.2.2. A second approach (Model 2) utilised
  12. Colorectal Cancer Screening Pilot Table 6.2.4: Relationship of uptake rate to characteristics of invited persons Independent variables Unstandardized Coefficients Std. Error Standardized Coefficients t Sig.
  13. (1994). Computer-Based vs. Manual Health Maintenance Tracking: A controlled trial. doi
  14. (1995). Department of Health’s requirement for mandatory collection of data on ethnic group of inpatients doi
  15. (1994). Dietary intervention in primary care: validity of the DINE method for diet assessment. doi
  16. (1997). Distressed or relieved? Psychological side effects of breast cancer screening in the Netherlands. doi
  17. (1996). Does Britain have ghettos?’, doi
  18. (1999). Ethnic Statistics: Better than Nothing or Worse than Nothing? Standard categories of ethnicity are often not appropriate",
  19. Ethnicity: UK Colorectal Cancer Screening Pilot Table 3.2.3 Overall comparison of survey participants and survey non-participants.
  20. (1991). Figure 1.3.1: Minority composition of Coventry and Warwickshire districts,
  21. (1987). Focus Group Interview: an underutilized research technique for improving theory and practice in health education’ doi
  22. (1990). Implementation preventative services: Success and failure in an outpatient trial. doi
  23. (1991). Inappropriate use of the term Asian - an obstacle to ethnicity and health research’
  24. (2002). Interventions targeted at women to encourage the uptake of cervical screening. doi
  25. (1998). It’s Our Health Too: Asian men’s health perspectives Southern Birmingham Community Health
  26. (1978). Mail and telephone surveys: the total design method. doi
  27. (1970). Manual for the State-Trait Anxiety Inventory (Selfevaluation questionnaire). Palto Alto, CA: Consulting Psychologists Press. UK Colorectal Cancer Screening Pilot (nd) Information Pack for Professionals Rugby: NHS Screening Programmes
  28. (2002). Nip it in the Bud’: Breast Screening Uptake and Women from Marginalised Communities, Liverpool: Centre for Health Environment and Wellbeing,
  29. (1927). No response Returned Complete Returned Blank Unavailable Total
  30. (1992). On the State of the Public Health for the Year doi
  31. (1990). One study indicates that a patient letter may be more cost-effective than a physician reminder (Belcher
  32. (1990). Predictors of older adults' participation in fecal occult blood screening. Oncology Nursing Forum
  33. (1992). professional perceptions and poor communication. For breast cancer screening, two early papers
  34. (1994). Race ethnicity culture and science’ doi
  35. (1996). Randomised control trial of faecal occult blood screening for colorectal cancer. doi
  36. (2003). Recent changes in lung cancer incidence for south Asians: a population based register study’ doi
  37. Result 2119 (240) Kit Returned 82746 (2525) Invitees (with 3 months follow up) 139850 (7469) Strong Positive 171 (8) Positive 98 (22) Further
  38. (1996). Reviews of ethnicity and health York: NHS Centre for Reviews and Dissemination
  39. (2001). ROLL-OUT: LIKELY CRC SCREENING UPTAKES The first breakdowns of
  40. (1990). Society. Cancer in the socioeconomically disadvantaged. doi
  41. (1991). Stratford Stratford Stratford GP practice GP practice GP practice GP practice GP practice GP practice GP practice GP practice Asian GP practice Minority ethnic groups percentage of population, doi
  42. (2001). Systematic review of ethnicity and health service access for London.
  43. (2001). Table 1.3.1: Categories of ethnic group recorded in the UK Censuses of 1991 and
  44. (2002). Table 3.1.1: Number of Subjects at Key Stages of CRC Screening Process Number A. Population covered as of
  45. (2002). Table 4.1.1: Number of Subjects at Key Stages of CRC Colonoscopy Process Number A. Population covered as of
  46. (2000). Table 4.1.2: Uptake of Colonoscopy (allowing at least three months from FOBt positive test result) by Demographic and Ethnic Factors Demographic/ Ethnic Factor Number Uptake (%)
  47. Table 4.1.3: Distribution of FOBt Positives Considered to be Defaulters by Reason (Based on English Pilot Site Nurse Records) Current Status Reason for defaulting Asian Non-Asian All Number %
  48. Table 6.2.2: Model 1 – Deprivation and country of birth Independent variables (derived from 1991 Census of Population) Unstandardized Coefficients Std. Error Standardized Coefficients t Sig. (Constant)
  49. Table 6.2.3: Model 2- Deprivation and ethnic group Independent variables (derived from 1991 Census of Population) Unstandardized Coefficients Std. Error Standardized Coefficients t Sig. (Constant) 60.339
  50. (1990). Task force on Minority Health. Closing the gap: a call for action.
  51. (2000). The Pilot sites were commissioned in 1999, and were required to undertake all of the necessary developmental work to commence screening in early 2000. The Scottish Pilot site commenced screening in
  52. (2003). The prediction of uptake rates in other parts of the UK has been largely based on 1991 Census of Population data, since detailed data from the 2001 Census was not available at the time of writing this report
  53. (1971). The Urban Mosaic: towards a theory of residential differentiation (Cambridge: doi
  54. (1992). The use of ethnicity and race in health research: a cautionary note’
  55. (1992). There are many ways of defining an ‘ethnic minority’ (Pringle et al 1997), and there has been considerable debate and controversy about the categories in use within the NHS (Bhopal 1991, Ahmad, Sheldon and Stuart 1996, Sheldon and Parker
  56. (1990). Three strategies to promote cancer screening: How feasible is wide-scale implementation. doi
  57. (2001). USED Data used for the extrapolations were taken from the 1991 and
  58. (1997). Using focus group methodology to develop breast cancer screening programs that recruit African American women’

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.